The Impact of Breast Implant Location on the Risk of Capsular Contraction

Egeberg, Alexander; Sørensen, Jens Ahm

doi:10.1097/sap.0000000000000227

Cited by 28 publications

(22 citation statements)

References 36 publications

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“…The disadvantages of the prepectorally placed implant may be an inferior cosmetic outcome due to thin tissue coverage and implant visibility as well as a higher risk of capsular contracture [4,9]. A meta-analysis from 2016 evaluating more than 17,000 implants found that the risk of significant capsular formation increased more than two-fold with subglandular placement of the implant compared to subpectoral in augmented women [28]. However, the risk of capsular contracture may be less when an acellular dermal matrix (ADM) or an AMM is used [4,29].…”

Section: Discussionmentioning

confidence: 99%

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Dyrberg

Gunnarsson

Bille

et al. 2020

Trials

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Background: Skin-sparing mastectomy followed by immediate implant-based breast reconstruction is a commonly used treatment for breast cancer. However, when placing the implant in a subpectoral pocket, a high incidence of breast animation deformity (BAD) has been reported. Besides the nuisance that BAD can cause, lifting of the pectoralis major muscle (PMM) can result in a more extended postoperative recovery period. When placing the implant solely prepectorally leaving the PMM undisturbed, the incidence and severity of BAD might be mitigated. However, new challenges may occur because of thinner skin cover. Methods/design: A prospective, multi-centre, randomised controlled trial will be carried out with the primary aim of assessing and comparing the incidence and degree of BAD in women having a direct-to-implant breast reconstruction with either a prepectorally or a subpectorally placed implant. The secondary outcomes are shoulder and arm function, quality of life, aesthetic evaluation, length of stay, complications, need for surgical corrections, and development of capsular contracture. A total of 70 included patients will be followed under admittance and at clinical check-ups 3 months and 1 year after surgery.Discussion: To our knowledge, this trial is the first randomised controlled trial evaluating and comparing subpectoral and prepectoral implant placement when performing direct-to-implant breast reconstruction following skin-sparing mastectomy. The results will hopefully provide us with a broader knowledge of the outcomes of immediate breast reconstruction, making better preoperative planning possible in the future by providing our patients with a more objective information. Trial registration: ClinicalTrials.gov, ID: NCT03143335. Prospectively registered on 8 May 2017.

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Section: Discussionmentioning

confidence: 99%

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Dyrberg

Gunnarsson

Bille

et al. 2020

Trials

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“…11 Reoperation rates for primary breast augmentation surgery approach 20% and are even higher for secondary augmentation over a patient's lifetime-the highest rate of all aesthetic procedures. 7,14 ■ CAPSULAR CONTRACTURE Capsular contracture is the most common complication of breast augmentation, 25 typically presenting within the fi rst postoperative year, 26,27 and the risk increases over time. 28 It occurs with both silicone and saline breast implants.…”

Section: ■ Implant Longevity and Rupturementioning

confidence: 99%

“…20 The etiology is not well understood and is presumed to be multifactorial, with proposed mechanisms and factors that include bacterial contamination, surface texturing, the implant pocket selected, the incision type, drain placement, antibiotic use, and smoking. 25 A meta-analysis from 17,000 implants found that the risk of capsular contracture was signifi cantly higher when an implant was placed in a subglandular pocket than in a submuscular pocket, 22,26 and that although texturing decreased capsular contracture compared with smooth implants, the effect was modest when a textured or smooth implant was placed in a submuscular location. 28 With regard to incision location, studies have reported that the incidence of capsular contracture is highest with transaxillary and periareolar incisions, and lowest with inframammary incisions.…”

Section: Considerations In Incision Locationmentioning

confidence: 99%

Breast augmentation surgery: Clinical considerations

Coombs

Grover

Prassinos

et al. 2019

CCJM

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Women receive breast implants for both aesthetic and reconstructive reasons. This brief review discusses the evolution of and complications related to breast implants, as well as key considerations with regard to aesthetic and reconstructive surgery of the breast. KEY POINTSNearly 300,000 breast augmentation surgeries are performed annually, making this the second most common aesthetic procedure in US women (after liposuction).Today, silicone gel implants dominate the world market, and in the United States, approximately 60% of implants contain silicone gel fi ller.Capsular contracture is the most common complication of breast augmentation, typically presenting within the fi rst postoperative year and with increasing risk over time. It occurs with both silicone and saline breast implants.Numerous studies have demonstrated the safety of silicone breast implants with regard to autoimmune disease incidence. However, the risk of associated anaplastic large-cell lymphoma must be discussed at every consultation, and confi rmed cases should be reported to a national registry.

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“…A paradigm shift in modern breast reconstruction occurred in 2001 with the introduction of acellular dermal matrix (ADM) allowing a direct to implant breast reconstruction that has become a standard procedure and evolved further using various types of biological and synthetic meshes (1)(2)(3)(4). The increased practice of one stage direct to implant reconstruction has resulted in an increased focus on the unsightly breast animation deformity (BAD) that has been suggested to be proportional to the degree of muscle involvement (5).…”

Section: Introductionmentioning

confidence: 99%

“…This change however, gives a resurgence of potential problems such as thin tissue coverage allowing visible implant edges, secondary ptosis and possibly increased rates of capsular contracture. These are potential risks, which needs to be examined in future studies (5,6). The aim of this visualized surgery paper was to visualize and highlight the technical disparities between a sub-and prepectoral direct to implant breast reconstructive techniques applied at our institutions.…”

Section: Introductionmentioning

confidence: 99%

Visualized pre- and subpectoral implant placement for immediate breast reconstruction

Dyrberg¹,

Bille²,

Gunnarsson³

et al. 2019

Gland Surg.

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The use of mesh for immediate breast reconstruction was introduced almost two decades ago. Lately, the number of prepectoral direct to implant breast reconstructions has increased as this technique seems to leave an unimpaired muscle function and may lead to less or no breast animation deformity (BAD) and quicker recovery. However, challenges still remain as there is a risk of thin tissue coverage, visible implant edges and secondary ptosis. In this visualized surgery paper, we visualize the technical disparities between the sub-and prepectoral direct to implant breast reconstruction.

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The Impact of Breast Implant Location on the Risk of Capsular Contraction

Abstract: Risk.

Cited by 28 publications

References 36 publications

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Breast augmentation surgery: Clinical considerations

Visualized pre- and subpectoral implant placement for immediate breast reconstruction

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