Capsular Contracture Rate In Low-Risk Population After Primary Augmentation Mammaplasty – A Retrospective Review

Purpose:  The safety of augmentation mammaplasty has increased dramatically in the last 20 years.  Capsular contracture (CC) is the most commonly reported complication described for augmentation mammaplasty.  The literature, however, has reported a falsely high incidence of CC due to the mixing of patients undergoing primary augmentation and reconstructive procedures.  Few studies have detailed CC rates in a purely primary augmentation population. 

Methods:  In our IRB-approved, retrospective study, we reviewed all patients who presented to a private plastic surgery practice from January 2000 through January 2008 who underwent primary augmentation as their sole procedure.  Data was collected from charts of 854 patients.  Data points include demographics, surgical approach, implant position, use of antibiotic irrigation, functional and aesthetic outcomes, complications including capsular contracture, and revision rate and type. 

Results:  The overall Grade III-IV CC rate over a mean follow-up period of 14.9 months was 2.8%. Lack of antibiotic irrigation use was associated with a CC rate of 3.9%, while using antibiotic irrigation decreased this rate to 0.4% (p = 0.004).  Saline implants had significantly higher CC and reoperation rates versus silicone implants (p = 0.032, p = 0.001).  Transaxillary incision approach was associated with a significantly higher rate of reoperation compared with inframammary incision (p = 0.017).  Smooth implants were associated with higher reoperation than textured implants (p = 0.032).  Tobacco use was associated with a 5.5% CC rate, while non-users had a CC rate of only 1.9% (p = 0.036).

Conclusions:  Patient populations should not be mixed when examining capsular contracture rates.  Nonetheless, primary augmentation patients receive educational materials quoting CC rates of 8-30%.  Based on our findings, it is apparent that the CC rate in primary augmentation is less than 1% at 1 year when patient and operative factors are optimized.  We highly advocate an inframmamary approach, submuscular implant placement, and antibiotic irrigation of the breast pocket for the standard primary augmentation patient.