Capsulectomy versus Capsulotomy to Treat Breast Capsular Contracture: a Systematic Review and Comparative Meta-Analysis

Abstract

Introduction: Capsular contracture (CC) is one of the most frequent complications after breast reconstruction or augmentation. The incidence varies between the studies, mainly due to a difference in follow-up and between cosmetic or reconstructive surgery. It is commonly accepted that the origin is multifactorial. However, the exact mechanism and etiology remain unexplained. Controversy regarding the role of infection, inflammation and autoimmunity in its development persists. Surgical treatment is required for Baker’s stage 3 and 4. The aim of this study was to compare recurrence risk in case of capsulectomy versus capsulotomy. Materials and Methods: A comprehensive literature search was performed on PubMed/MEDLINE, including all studies examining recurrence risk following capsulectomy or capsulotomy to treat CC. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were applied to identify relevant articles. Results: After screening 130 articles initially identified, we finally selected for analysis 21 papers which met inclusion criteria. No randomized controlled trial was found. Despite the majority of the authors favoring capsulectomy as gold standard’s treatment for CC, our meta-analysis showed a lower recurrence rate with the use of capsulotomy versus capsulectomy. However, no statistically significant difference was observed. Conclusion: There is no consensus algorithm for the surgical management of CC. The meta-analysis of all existing literature did not allow to draw conclusions in favor of capsulectomy or capsulotomy in terms of capsular recurrence. The only point on which all authors agree is the need of “en-bloc capsulectomy” to treat Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, the reduction of perioperative complication in case of capsulotomy may orient towards this method given similar long-term CC risks. Large prospective randomized controlled studies comparing the two methods are warranted to optimize care.