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Surgical Management of Breast Capsular Contracture—A Multi-institutional Data Analysis of Risk Factors for Early Complications

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  • Breast Surgery
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Abstract

Background

Capsular contracture (CC) is a common complication following implant-based breast surgery, often requiring surgical intervention. Yet, little is known about risk factors and outcomes following CC surgery.

Methods

We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008–2021) to identify female patients diagnosed with CC and treated surgically. Outcomes of interest included the incidence of surgical and medical complications at 30-days, reoperations, and readmissions. Confounder-adjusted multivariable analyses were performed to establish risk factors.

Results

5,057 patients with CC were identified (mean age: 55 ± 12 years and mean body mass index [BMI]: 26 ± 6 kg/m2). While 2,841 (65%) women underwent capsulectomy, capsulotomy was performed in 742 patients (15%). Implant removal and replacement were recorded in 1,160 (23%) and 315 (6.2%) cases, respectively. 319 (6.3%) patients experienced postoperative complications, with 155 (3.1%) reoperations and 99 (2.0%) readmissions. While surgical adverse events were recorded in 139 (2.7%) cases, 86 (1.7%) medical complications occurred during the 30 day follow-up. In multivariate analyses, increased BMI (OR: 1.04; p = 0.009), preoperative diagnosis of hypertension (OR: 1.48; p = 0.004), and inpatient setting (OR: 4.15; p < 0.001) were identified as risk factors of complication occurrence.

Conclusion

Based on 14 years of multi-institutional data, we calculated a net 30 day complication rate of 6.3% after the surgical treatment of CC. We identified higher BMI, hypertension, and inpatient setting as independent risk factors of postoperative complications. Plastic surgeons may wish to integrate these findings into their perioperative workflows, thus optimizing patient counseling and determining candidates’ eligibility for CC surgery.

Level of Evidence III

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Funding

The authors received no funding for data collection or preparation of the manuscript. The authors have no relevant financial disclosures.

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Author notes

  1. Bohdan Pomahac and Martin Kauke-Navarro have equally contributed to this present work.

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Samuel Knoedler, Leonard Knoedler, Sam Boroumand, Fortunay Diatta, Lioba Huelsboemer, Haripriya Ayyala, Omar Allam, Bohdan Pomahac & Martin Kauke-Navarro

  2. Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany

    Michael Alfertshofer

  3. Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Giuseppe Sofo

  4. Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen, Germany

    Frederik J. Hansen

  5. Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland

    Sören Könneker & Bong-Sung Kim

  6. Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Filippo A. G. Perozzo

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  1. Samuel Knoedler
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Correspondence to Martin Kauke-Navarro.

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Knoedler, S., Knoedler, L., Boroumand, S. et al. Surgical Management of Breast Capsular Contracture—A Multi-institutional Data Analysis of Risk Factors for Early Complications. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04203-x

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