Background: Capsular contracture following augmentation mammoplasty is the most common complication requiring revision surgery. However there is a lack of single surgeon’s long term follow up regarding this most common complication. Methods: Retrospective data was retrieved using XL Spread Sheet, primary augmentation mammoplasty performed between May 1999 and August 2015 was reviewed. All patients had their surgery performed and followed up by a single surgeon. All patients had textured round cohesive gel silicone implants using inframammary incision with a minimum follow up of 1.5 years, were selected. Asymptomatic capsular contractures (Baker Grade I and II) were compared with symptomatic contractures (Grade III and IV) on the basis of the age of the patient, size of the implants and duration of implantation. Asymptomatic and symptomatic capsular contracture rate was also compared based on the position of the implants, smoking status of the patients and presence and absence of the drains. Results: There were 117 patients with a mean follow up of 6.6 years (range 1.5-12) in the series. Mean age of the patients was 32.2 years (range 18-53) with a mean implant size of 336.2 cc (range 230-540). Of 117 patients, 107 (91.5%) were asymptomatic with a mean age of 31.9 years , mean implant size of 336 cc with a mean implantation of 6.7 years as compared to symptomatic capsular contracture present in 10 patients (8.5%) with a mean age of 35.3 years, mean implant size of 339cc and with a mean duration of 6 years. Of the 49 patients who had mammoplasty in subglandular pocket, 3 (6.1%) presented with Grade III or IV capsular contracture. Submuscular augmentation was performed in 68 patients, of these 7 (10.3%) presented with symptomatic capsular contracture. Smoking status was known in 114 patients. Of these 114, 25 were smokers and Grade III and IV capsular contracture was present in 2 patients (8.0%) as compared to 89 non smokers of whom 8 (9.0%) presented with Grade III-IV capsular contracture. Drains were used in 15 patients, of these 2 patients (13.3%) developed capsular contracture. Of the 102 patients who had their surgery without drains, 8 patients (7.8%) developed Grade III-IV capsular contracture. Of the 117 patients, 11 patients who had implants failures, 3 (27.3 %) presented with Grade III-IV capsular contracture as compared 6 (11.8%) of the 51 patients who did not have implant damage. Conclusion: Incidence of capsular contracture in current long term series was 8.5%. There was no single cause identified for capsular contracture, including pocket of the implant placement, use of drains, smoking or implant rupture.
1. Adjic D, Zoghbi Y, Gerth D, Panthaki ZJ, Thaller S. The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants. Aesthetic Plast Surg,2016;36:297309
2. Cunningham B. The Mentor Core Study on Silicone Memory Gel Breast Implants. Plast. Reconstr. Surg. 2007;120(7 Suppl 1):19S-Pl29S
3. Codner MA, Mejia JD, Locke MB, Mahoney A, Thiels C, Nahai FR, Hester TR, Nahai F. A 15-Year Experience with Primary Breast Augmentation.Plast. Reconstr. Surg 2011;127:1300-1314
4. Bengston BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP; for the Style 410 U.S Core Clinical Study Group. Style 410 Highly Cohesive Silicone Breast Implant Core Study Results at 3 Years. Plast. Reconstr. Surg. 2007;120(7 Abstract Suppl !):40S-48S
5. Maxwell GP, Van Natta BW, Bengston BP, Murphy DK. Ten-Year Results From Natrelle 410 Anatomical Form- Stable Silicone Breast Implant Core S t u d y . A e s t h e t i c P l a s t Surg.2013;35:145-155
6. Stevens WG, Harrington J, Alizadeh K, Broadway D, Zeidler K, Godinez TB. Eight-Year Follow-Up Data from the U.S. Clinical Trial for Sientra’s FDAApproved Round and Shaped Implants with High-Strength Cohesive Silicone G e l . A e s t h e t i c P l a s t Surg.2015;35(S1);S3-S10
7. Handel N, Cordray T, Gutierrez J, Jensen JA. A Long-Term Study of Outcomes, Complications, and Pateint Satisfaction with Breast Implants.Plast. Reconstr. Surg.2006;1177:757-767
8. Tebbet JB. Achieving a Zero Percent Reoperation Rate at 3 Years in a 50- Consecutive-Case Augmentation Mammoplasty Premarket Approval S t u d y . P l a s t . R e c o n s t r . Surg.2005;118:1453–7
9. Costagliola M, Atiyeh BS, Rampillon F. An Innovative Procedure for the treatment of Primary and Recurrent Capsular Contracture (CC) Following Breast Augmentation. Aesthetic Plast Surg.2013;33:1008-1017
10. Barone FE, Perry L, Keller T, Maxwell G P . T h e B i o m e c h a n i c a l a n d Histopathologic Effects of Surface T e x t u r i n g w i t h S i l i c o n e a n d
Polyurethane in Tissue Implantation and E x p a n s i o n . P l a s t . R e c o n s t r . Surg.1992;90:77-86
11. Maxwell GP, Scheflan M, Spear S, Nave BM, Haden P. Benefit and Limitation of Macrotextured Breast Implants and Consensus Recommendations for Optimising Their Effectiveness. Aesthetic Plast Surg.2014;34:876-881
12. Neal Handel. Long-Term Safety and Efficacy of Polyurethane Foam-covered Breast Implants. Aesthetic Plast Surg.2006;26:265-274
13. Burkhardt BR, Fried M, Schnur PL, Tofield JJ. Capsules, Infection, and Intraluminal Antibiotics. Plast. Reconst. Surg.1981. 81;68:43-49
14. Biggs TM, Yarish RS. Augmentation Mammoplasty: A comparative Analysis. Plast. Reconst. Surg.1989;85:368-372
15. Flugstad NA, Pozner jn, Baxter RA, Creasman C, Egrari S, Martin S, Messa III CA, Oliva A, Schlesinger L, Kortesis BG. Does Implant Insertion with a Funnel Decrease Capsular Contracture? A preliminary Report. Aesthetic Surg J 2014;36:550-556
16 Deva AK, Commentaryon: Does Implant Insertion with a Funnel Decrease Capsular Contracture? A preliminary Report. Aesthetic Surg J 2014;36:557-558
17. Courtiss EH, Golgwyn RM, Anastasi GW. The Fate of Breast Implants with Infections Around them.Plast Reconstr Surg.1979;63:812-16
18. Khan UD. Breast Augmentation, Antibiotic Prophylaxis and Infection: Comparative Analysis of 1628 Primary Augmentation Mammoplasties to Assess the Role and Efficacy of Length of Antibiotic Prophylaxis. Aesth Plast Surg.2010; 34:42-47.
19. Virden CP, Dobke MK, Stein P, Parsons CL, Frank DH. Sibclinical infection of the silicone breast implant surface as a possible cause of capsular contracture.Aesthete Plast Surg.1992;16:173-179
20. Pajkos A, DevaAK, Vickery K, Cope C, Chang L,Cossart YE. Detection of subclinical infection in significant b. reast implant capsules. Plast Reconstr Surg. 2003:111:1605-1611
21. Khan UD. Secondary Augmentation Mammoplasties and Periprosthetic Infection. A Three Year Retrospective R e v i e w o f 9 2 S e c o n d a r y Mammoplasties Performed by a Single Surgeon. Aesthetic Surg J.2012; 32:465- 473
22. Persichetti P, Segreto F, PendolinoAL, Buono RD, Marangi GF. Breast Capsule Flaps and Grafts: A Review of the Literature.2014;38:540-548
23. Spear SL, Carter ME, Ganz JC. The Correction of Capsular Contracture by C o n v e r s i o n t o “ D u a l – P l a n e ” Positioning: Technique and Outcomes. Plast. Reconstr Surg. 2002;12:456-467
24. K h a n U D . H i g h T r a n s v e r s e Capsuloplasty for the Correction of Malpositioned Implants Following Augmentation Mammoplasty in Partial
Submuscular Plane. Aesth Plast Surg.2012; 36:590-599
25. Khan UD. Subglandular to Muscle Splitting Biplane Conversion for Revision Augmentation Mammoplasty. In: Mugea TT, Schifmann MA, editors. Aesthetic Surgery of the Breast. 1st ed. Berlin: Springer; 2015. p. 535-41.
26. Henriksen TF, FryzekJP, HolmichLR, McLoughlin JK, Kjo;;erK, Hoyer AP, Olsen JH,Friis S. Surgical Intervention and Capsular Contracture After Breast Augmentation. A prospective Study and of Risk Factors. Annals od Plastic Surger. 2005;54:343-351
All published material becomes the sole property of the Pakistan Journal of Plastic Surgery, copyrighted by the Pakistan Association of Plastic Surgeons (PAPS). By submitting an article or brief communication, all authors agree to these conditions.
During the submission process, all authors have required to complete a copyright transfer agreement, “Author Consent form” By completing the copyright transfer agreement, you are transferring copyright of figures, tables, videos, and the content of the manuscript to the Pakistan Association of Plastic Surgeons (PAPS).
If you do not wish to or cannot transfer copyright of some or all of your content, please contact the editorial office at pjpspakistan@gmail.com