Surgical treatment for capsular contracture: A new paradigm and algorithm
Andrew L. Weinstein, M.D., M.S.1, David A. Hidalgo, M.D.2.
1New York - Presbyterian Hospital, New York, NY, USA, 2Weill Cornell Medicine, New York, NY, USA.
Background: Capsular contracture is the most common complication after breast augmentation and surgical treatment with conventional techniques has a high failure rate. Acellular dermal matrix (ADM) is emerging as a new therapeutic adjunct to improve capsulectomy success, but adds considerable time and cost to the procedure. The purpose of this study was to develop a capsular contracture treatment algorithm that uses ADM selectively to optimize success rates.
Methods: All patients who underwent surgical treatment for Baker grade III/IV capsular contracture after breast augmentation between 2007 and 2017 were included in this retrospective cohort study. The primary outcome was treatment success defined as achieving Baker grade II or better. Data were collected on patient characteristics, breast augmentation, capsular contracture, and surgical treatment. The proposed treatment algorithm was analyzed via generalized linear mixed modeling with random effects.
Results: 166 patients underwent 195 surgical treatments for capsular contracture, which was unilateral in 53% of cases and bilateral in 47%. 179 cases involved capsulectomy alone and 16 capsulectomy and ADM. 21 patients were treated for a second occurrence and 3 were treated for a third. With an average follow-up period of 2.5 years, success rate using capsulectomy alone was 74% on first occurrence, 60% on second occurrence, and 50% on third occurrence. ADM was successful in all cases. Regression analysis revealed that the odds of conventional treatment failure were highest for bilateral capsular contracture (1.9 times) and previous treatment failure (5.3 times), and guided treatment algorithm development. When the proposed algorithm (Figure) was evaluated using patient outcomes from this study, treatment success rate was 85% compared with only 65% when the algorithm was not followed, p=0.004.
Conclusions: As an adjunct to capsulectomy, ADM may be used selectively in patients at increased risk for capsular contracture treatment failure to significantly improve success rates. The proposed algorithm is therefore recommended for all patients undergoing surgical treatment for Baker grade III/IV capsular contracture after breast augmentation. 
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