Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic Review

Background: Capsular contracture is a complication of breast augmentation that frequently requires revision surgery. "Capsulectomy, site change, and implant exchange" has been referred to as the gold standard treatment of clinically significant contractures. However, the actual clinical evidence behind this algorithm remains elusive at best. A systematic review of the literature was performed to clarify the true evidence behind the surgical management of capsular contracture. Methods: A search of the MEDLINE database was performed for clinical studies involving the surgical treatment of capsular contracture following breast augmentation. Resulting articles were reviewed using a priori criteria. Results: The systematic review was performed in April of 2015. The primary search for "breast augmentation" yielded 9490 articles. When filtered for "treatment of capsular contracture," 461 articles resulted. Review of these articles and pertinent references using a priori criteria yielded 24 final articles. No controlled trials met final inclusion criteria. Conclusions: There is limited clinical evidence behind the surgical management of capsular contracture. Site change and implant exchange are associated with reduced contracture recurrence rates and likely play a beneficial role in treating capsular contracture. The data on capsulectomy are less conclusive. Acellular dermal matrix may be a useful adjunct but still requires long-term data.