TY - JOUR
T1 - Capsular contracture in the modern era
T2 - A multidisciplinary look at the incidence and risk factors after mastectomy and implant-based breast reconstruction
AU - Hammond, Jacob B.
AU - Kosiorek, Heidi E.
AU - Cronin, Patricia A.
AU - Rebecca, Alanna M.
AU - Casey, William J.
AU - Wong, William W.
AU - Vargas, Carlos E.
AU - Vern-Gross, Tamara Z.
AU - McGee, Lisa A.
AU - Pockaj, Barbara A.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/5
Y1 - 2021/5
N2 - Background: Capsular contracture causes pain, poor cosmesis, and reoperations. This study analyzes its incidence and risk factors in a more modern treatment era. Methods: Patients undergoing mastectomy with implant reconstruction from 2010 to 18 were reviewed. Univariate and multivariate analysis evaluated rates and risk factors for capsular contracture. Results: Among 451 patients, the majority underwent nipple-sparing mastectomy (262, 58.1%) with one-stage reconstruction (283, 62.7%) utilizing subpectoral implants (353, 77.4%) and acellular dermal matrix (354, 78.5%). Overall capsular contracture incidence was 9.8%; the rate after post-mastectomy radiation therapy (PMRT) was 18.7%, and 7.5% for patients without PMRT. Significant factors included neoadjuvant chemotherapy (P = 0.006), hematoma (P = 0.047), and PMRT (P = 0.001). Multivariate analysis showed that PMRT increased risk of capsular contracture (OR = 3.12, 95% CI 1.55–6.26, P = 0.001), and adjuvant chemotherapy was protective (OR = 0.289, 95% CI 0.114–0.731, P = 0.01). Conclusions: Incidence of capsular contracture is lower than previously reported. Advancing therapeutic techniques may reduce the risk of this complication.
AB - Background: Capsular contracture causes pain, poor cosmesis, and reoperations. This study analyzes its incidence and risk factors in a more modern treatment era. Methods: Patients undergoing mastectomy with implant reconstruction from 2010 to 18 were reviewed. Univariate and multivariate analysis evaluated rates and risk factors for capsular contracture. Results: Among 451 patients, the majority underwent nipple-sparing mastectomy (262, 58.1%) with one-stage reconstruction (283, 62.7%) utilizing subpectoral implants (353, 77.4%) and acellular dermal matrix (354, 78.5%). Overall capsular contracture incidence was 9.8%; the rate after post-mastectomy radiation therapy (PMRT) was 18.7%, and 7.5% for patients without PMRT. Significant factors included neoadjuvant chemotherapy (P = 0.006), hematoma (P = 0.047), and PMRT (P = 0.001). Multivariate analysis showed that PMRT increased risk of capsular contracture (OR = 3.12, 95% CI 1.55–6.26, P = 0.001), and adjuvant chemotherapy was protective (OR = 0.289, 95% CI 0.114–0.731, P = 0.01). Conclusions: Incidence of capsular contracture is lower than previously reported. Advancing therapeutic techniques may reduce the risk of this complication.
KW - Breast reconstruction
KW - Capsular contracture
KW - Mastectomy
KW - Nipple-sparing
KW - Risk factors
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U2 - 10.1016/j.amjsurg.2020.09.020
DO - 10.1016/j.amjsurg.2020.09.020
M3 - Article
C2 - 32988607
AN - SCOPUS:85091530683
SN - 0002-9610
VL - 221
SP - 1005
EP - 1010
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -