Capsular contracture in the modern era of combined breast cancer treatment: a multidisciplinary perspective on incidence and risk factors

BACKGROUND: Implant-based breast reconstruction in contrast to autologous reconstruction often requires revision surgery and ultimately leads to reconstructive failure, especially in adjuvant radiation therapy. Capsular contracture remains the most common complication leading to unsatisfactory aesthetic results. To date, there is no therapeutic target for the direct treatment of capsular contracture, which emphasizes the importance of its prevention. AIM: To determine the incidence and risk factors of capsular contracture in the era of multidisciplinary breast cancer treatment using modern surgical and therapeutic approaches. MATERIALS AND METHODS: The following retrospective study included 416 patients after mastectomy with immediate or delayed implant-based breast reconstruction in combination with adjuvant radiation therapy. Features of the surgical intervention, neoadjuvant and/or adjuvant systemic therapy were analyzed to determine the association with the risk of developing capsular contracture. RESULTS: Capsular contracture during alloplastic reconstructive plastic surgery with adjuvant radiation therapy, according to the literature, is a common complication with a complex and multifactorial pathogenesis. Despite the low incidence of capsular contracture III–IV Baker scale in the present study (7.7%, 32/416), the majority of patients required revision surgery (90.6%, 29/32). There was no correlation between risk of capsular contracture depending on the systemic treatment (z 1.96). CONCLUSIONS: The development of capsular contracture was significantly influenced by nipple-sparing mastectomy (13.7%, 22/167; z = 3.25) and the choice of periareolar access during surgery (29.6%, 13/44; z 1.96). Immediate one-stage reconstructions are associated with a significant number of capsular contractures (15.2%, 24/158; z 1.96), which statistically significantly depend on the subpectoral location of the endoprosthesis (22.1%, 21/95; z = 2.79) and choice of textured implants (20.8%, 22/106; z = 2.02).