With the continuation of augmentation mammaplasty as a desirable operation for a large segment of the female population in the United States, the problem of fibrous capsular contracture that has been present since the inception of the operation has persisted. Various approaches to the problem have been entertained, and a lessening of the incidence has occurred as reviewed in our earlier report, which follows augmentation mammaplasty in our clinic from 1962 through 1979.
In this retrospective study, no significant difference in contracture rate was seen based on patient smoking habits, operative approach used, or implant type. It is important to note that the total experience with the low-bleed implant was significantly lower in terms of number of patients meeting the criteria of this retrospective study than the standard gel mammary implant. Greater follow-up time and number of patients will be evaluated in future retrospective studies.
We have demonstrated in this study that placement of the implant beneath the pectoral muscle has significantly diminished the incidence of capsular contracture both as Baker grades II, III, and IV and as Baker grades III and IV. The retropectoral site has become the preferred location for the prosthesis in our clinic. There is no appreciable alteration in the overall shape of the breasts from this approach, and therefore, it will continue to be the preferred method. Rates of incidence of hematoma, the most frequent adverse reaction after contracture, were not significantly different between the retropectoral and retromammary implant sites.
An interesting, and somewhat unexpected, outcome of the study was the significantly higher contracture rate seen with the use of steroids versus no steroids in the pocket. This observation deserves further study.