Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

Abstract

Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.

Keywords: Breast implants; Capsular contracture; Mammoplasty.

Fig. 1. Grade IV capsular contracture

This is a picture of a 40-year-old woman who has Baker grade IV capsular contracture. On the left, the breast is noticeably higher and there is noticeable skin puckering along the medial side. The nipple is higher relative to the right side.

Fig. 2. Atypical large cell lymphoma complicating augmentation mammoplasty

These are microphotographs showing the appearance of anaplastic large cell lymphoma in the capsule surrounding an implant. Most cases are of a B-cell phenotype. Pleomorphic cells with anaplastic nuclei and prominent nucleoli can be seen. The magnifications are as follows: (A) ×0.35, (B) ×5.09, (C) ×11.1, and (D) ×28.1. All micrographs show H&E staining.