Recurrence of subglandular breast implant capsular contracture: Anterior versus total capsulectomy

The objective of this study was to determine whether the type of capsulecto my, anterior or total, affects the recurrence of capsular contracture aroun d subglandular silicone-gel breast implants. A retrospective analysis was p erformed of patients who underwent either anterior or total capsulectomy fo r Baker grade 3 or 4 subglandular capsular contracture in our unit. All pat ients were invited to a review clinic where their capsular status was asses sed. There were 100 anterior disc capsulectomies in 60 patients between 198 8 and 1997 and 99 total capsulectomies in 60 patients between 1990 and 1998 . The follow-up in the former group was a median of 7 years and mean 6.9 ye ars, compared with median 2.5 and mean 3.1 years in the latter group. Eight y-six percent of the implants removed from both groups at capsulectomy were smooth-walled gel-filled implants. Sixty-nine breasts in the anterior grou p received textured gel implants at capsulectomy; the remaining 31 received polyurethane-coated Meme implants. In the total capsulectomy group, all bu t two breasts (one patient) received textured gel implants. After review, t he capsular status was known in 80 percent of the anterior and 92 percent o f the total capsulectomy group. The review clinic found eight new contractu res in five patients to have developed in the anterior compared with none i n the total group. Recurrent contractures affected 50 percent of patients ( 46 percent of breasts) in the anterior and 11 percent of patients (10 perce nt of breasts) in the total capsulectomy group. Kaplan-Meier survival analy sis was applied to the data. By including only patients who received textur ed gel implants at capsulectomy, the Logrank found a statistical difference between the two treatment groups. (0.01 < p < 0.05). We believe that this study provides some evidence that total capsulectomy f or subglandular silicone breast implant capsular contracture results in a l ower capsular recurrence than anterior disc capsulectomy. The pattern and r isk of recurrence after total capsulectomy and exchange for a modern textur ed prosthesis appear to approach those following primary augmentation.