Fw: Recurrence of Subglandular Breast Implant Capsular Contracture:Anterior versus Total Capsulectomy

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From: Ilena Rose <ilena@...>

Sent: Thursday, February 22, 2001 2:09 PM

Subject: Recurrence of Subglandular Breast Implant Capsular

Contracture:Anterior versus Total Capsulectomy

Recurrence of Subglandular Breast Implant Capsular Contracture: Anterior

versus Total Capsulectomy

Collis, B.Sc., F.R.C.S.(Ed.); T. Sharpe, O.B.E., M.A.,

F.R.C.S.

From the Department of Plastic Surgery at Bradford Royal Infirmary and the

Plastic Surgery and Burns Research Unit at the University of Bradford.

PLASTIC AND RECONSTRUCTIVE SURGERY 2000;106:792-797

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The objective of this study was to determine whether the type of

capsulectomy, anterior or total, affects the recurrence of capsular

contracture around subglandular silicone-gel breast implants. A

retrospective analysis was performed of patients who underwent either

anterior or total capsulectomy for Baker grade 3 or 4 subglandular

capsular contracture in our unit. All patients were invited to a review

clinic where their capsular status was assessed. There were 100 anterior

disc capsulectomies in 60 patients between 1988 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 years, compared with

median 2.5 and mean 3.1 years in the latter group. Eighty-six percent of

the implants removed from both groups at capsulectomy were smooth-walled

gel-filled implants. Sixty-nine breasts in the anterior group received

textured gel implants at capsulectomy; the remaining 31 received

polyurethane-coated MÍme implants. In the total capsulectomy group, all

but two breasts (one patient) received textured gel implants. After

review, the capsular status was known in 80 percent of the anterior and 92

percent of the total capsulectomy group. The review clinic found eight new

contractures in five patients to have developed in the anterior compared

with none in the total group. Recurrent contractures affected 50 percent

of patients (46 percent of breasts) in the anterior and 11 percent of

patients (10 percent of breasts) in the total capsulectomy group.

Kaplan-Meier survival analysis was applied to the data. By including only

patients who received textured gel implants at capsulectomy, the Logrank

found a statistical difference between the two treatment groups (0.01 < p

< 0.5).

We believe that this study provides some evidence that total capsulectomy

for subglandular silicone breast implant capsular contracture results in a

lower capsular recurrence than anterior disc capsulectomy. The pattern and

risk of recurrence after total capsulectomy and exchange for a modern

textured prosthesis appear to approach those following primary

augmentation. (Plast. Reconstr. Surg. 106: 792, 2000.)