Abstract
Capsular contracture is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. PubMed was searched for studies, published from 2015 to 2020, focused on potential risk factors and preventions of capsular contracture (CC) in patients who underwent implant-based breast surgery. A total of 533 articles were identified from PubMed, and 13 articles were selected ultimately for our review after eligibility screening and quality appraisal. Common risk factors of CC include biofilm, surgical site infections (SSI), history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix (ADM), leukotriene (LTE) inhibitors, surgical techniques, and others. Multiple risk factors are proposed to be a component of the pathophysiology of CC. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. While efforts are being undertaken to solve this complication with improved technologies and surgical practices, CC remains to be unsolved. Our objective was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.
Highlights
BackgroundBreast cancer is the most frequently diagnosed cancer in women around the world, and up to 41% of patients who undergo mastectomy receive breast reconstruction [1]
This study aims to review the risk factors associated with CC and to outline the available preventative and treatment measures to reduce the rate of CC
We identified 533 publications total from PubMed PubMed Central (PMC) and Medical Subject Heading (MeSH) search and excluded 520 publications due to duplication, ineligibility, incomplete data, and irrelevance to our topic
Summary
BackgroundBreast cancer is the most frequently diagnosed cancer in women around the world, and up to 41% of patients who undergo mastectomy receive breast reconstruction [1]. The main goals of breast reconstruction are to reshape the breast due to tissue loss following breast cancer; to revise and fix the previous reconstruction surgery; and to augment the breast for cosmetic purposes. Along with its advantages for physical and psychological satisfaction given for the patients, complication rates are high following implant-based breast reconstruction especially for capsular contracture (CC). Up to half of the patients develop CC, and 30% of them suffer from CC with Baker rates III and IV following implantbased breast reconstruction [3,4]. Breast surgery is considered to be a clean surgery but the postoperative SSI rate rises by 2%-2.9% in augmentation and is the most common cause of readmission [7,8]. The common organisms identified are Staphylococcus epidermidis and S. aureus, Escherichia, Pseudomonas, Propionibacterium, and Corynebacterium [9,10]
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