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Capsular Contractures: A Systematic Review

Araco, Antonino M.D.; Caruso, Riccardo M.D.; Araco, Francesco M.D.; Overton, John; Gravante, Gianpiero M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1808-1819
doi: 10.1097/PRS.0b013e3181bf7f26
Breast: Original Articles

Background: The aim of this article was to review the current literature on capsular contractures, focusing in particular on the epidemiology, risk factors, cause, and treatment modalities, to provide the plastic surgeon with an up-to-date review of the current available evidence.

Methods: A literature search was undertaken of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases. The search strategy was conducted using three groups of key words, with the first relating to the organ involved (breast), the second relating to the surgical procedure performed and related technical issues, and the third relating to the surgical complications. Potentially relevant articles were identified by means of the title and the abstract, and full articles were obtained and assessed in detail.

Results: Only a few studies have included large enough sample sizes, were conducted in a prospective manner, were adequately randomized, and achieved adequate follow-up periods to obtain a true measure of rates of capsular contraction occurrence. Recent advances in molecular biology, microbiology, immunology, and basic pathology have outlined some of the mechanisms that underlie this phenomenon. Revision surgery remains the only effective treatment option available but is limited by its high associated risk of recurrences. No adequate preventative measures exist in practice, beyond the avoidance of risk factors.

Conclusions: Although a great deal of progress has been made over the past few decades, the exact nature and contribution of molecular, immunologic, and microbiological factors remain unclear. It is hoped that future studies will focus on attempting to resolve some of the issues highlighted in this review.

Bromsgrove, London, and Leicester, United Kingdom; and Rome, Italy

From Dolan Park Hospital; the III° Surgical Clinic, Department of Surgical Sciences, University “La Sapienza” of Rome; the Department of Surgery, University Tor Vergata; Barts and the London School of Medicine and Dentistry; and the Department of Surgery, University Hospitals of Leicester.

Received for publication March 1, 2009; accepted June 12, 2009.

Disclosure:The authors have no financial relationship with any institution or pharmaceutical company mentioned in the article, nor did they receive any funding for its writing.

Antonino Araco, M.D., 56 Hewell Road, Barnt Green, Bromsgrove, United Kingdom, aracoantonino@hotmail.it

©2009American Society of Plastic Surgeons