Surgical Intervention and Capsular Contracture After Breast Augmentation

Abstract

Epidemiologic data on local complications after breast augmentation are scarce. In particular, few prospectively collected data are available on modern breast implants on this issue. Using data from the Danish Registry for Plastic Surgery of the Breast, the authors examined determinants of surgery-requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically within the study period. Submuscular placement of the implant decreased the risk of capsular contracture grades III to IV (RR, 0.3; 95% CI, 0.2-0.8), whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture. Current surgical practices and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past. This prospective study indicates that surgical procedures are more important predictors for local (short-term) complications than implant or patient characteristics.

Transabdominoplasty-Breast Augmentation (TABA): a Series of 150 Consecutive Patients with Implications for Capsular Contracture.

“…Of note by the senior author, an excellent outcome for both procedures can be performed with not only no additional morbidity with the combined procedures, but also a marked reduction of capsular contracture graded higher than a Baker I, relative to traditional dual incision approaches [6][7][8][9][10]. The implications for capsular contracture in this study in general are, in the senior author's view, significant, given that the senior author's experience of several thousand breast augmentations in his career, have yielded the classic rate of capsular contracture between 5 and 10% [11][12][13][14].…”

The Effects of Vascular Endothelial Growth Factor on Capsule Formation around Silicone Implant in Rats

“…The exact pathophysiology of capsular contracture remains unclear, but previous studies have suggested that it is associated with chronic inflammatory factors, such as a foreign body reaction to the implant, the surface property of the implant, site of implant placement, postoperative bacterial infections, hematoma, or seroma [5,6]. Studies have examined whether inhibiting inflammatory events that cause a fibrosis is effective in preventing the capsular contracture, demonstrating that anti-inflammatory agents (e.g., calcium channel blockers), angiotensin-converting enzyme inhibitors, and leukotriene receptor antagonists (e.g., zafirlukast and montelukast) were effective in reducing the degree of capsular contracture [7][8][9][10][11].…”

Effectiveness of antibacterial copper additives in silicone implants

“…[4][5][6] Capsular contracture around breast implants is an unpredictable and common complication after breast augmentation and reconstruction with an overall prevalence of up to 17%. [7][8][9][10][11][12] Growing evidence suggests that capsular contracture is associated with subclinical infection of breast implants. The predominantly isolated microorganism from bacteriologic cultures of contracted capsules is Staphylococcus epidermidis.…”