Surgical Management of Capsular Contracture in Aesthetic Breast Surgery

Abstract

Introduction: Capsular contracture remains the most common long-term complication following implant-based breast augmentation and reconstruction. This literature review evaluates surgical strategies for prevention and treatment.

Methods: A literature search focused on studies reporting outcomes of capsulectomy, implant exchange, acellular dermal matrix use, and pocket change techniques. Inclusion: studies with ≥20 patients and follow-up of at least one year. Recurrence rates were the primary outcome.

Results: Twenty-nine studies were reviewed. Total capsulectomy with implant exchange yielded recurrence rates of 15-25% at five years. Addition of acellular dermal matrix reduced recurrence to 8-12%. Pocket change from subglandular to submuscular lowered recurrence to 10%. Partial capsulectomy alone had higher recurrence (30-40%). Textured implants showed no advantage over smooth in contracture recurrence.

Discussion: Complete capsulectomy and implant replacement are essential. ADM appears beneficial but adds cost. Patient factors such as history of irradiation increase recurrence risk.

Conclusions: Total capsulectomy with implant exchange and pocket change is the standard. ADM should be considered in high-risk patients. Prevention remains superior to treatment.