Capsular contracture following augmentation mammaplasty: Etiology and pathogenesis

Abstract

From a biological standpoint, encapsulation of a foreign body too large to be eliminated by phagocytosis is a normal occurrence. Capsular contracture occurs in zero to 74% of breast implants, depending on the series. Contemporary analysis of capsules shows a somewhat more sophisticated histological description of a complex structure consisting of three distinct layers. The internal layer adjacent to the prosthesis surface appears to be either single-layered or multilayered containing macrophages and fibroblasts. The middle layer is composed of loosely arranged connective tissue including the internal vascular supply, while a third layer consists of a dense connective tissue containing an external vascular supply. Current evidence supports the concept that prosthesis placement in the submuscular plane reduces --in some studies markedly --the incidence of capsular contracture, particularly severe contraction. Given the generally dismal record of treating established contracture, it must be concluded that redoubled efforts to prevent its occurrence offer the only satisfactory solution to this problem. © 2009 Springer-Verlag.