Capsular contracture in the modern era of combined breast cancer treatment: a multidisciplinary perspective on incidence and risk factors

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Abstract

BACKGROUND: Implant-based breast reconstruction in contrast to autologous reconstruction often requires revision surgery and ultimately leads to reconstructive failure, especially in adjuvant radiation therapy. Capsular contracture remains the most common complication leading to unsatisfactory aesthetic results. To date, there is no therapeutic target for the direct treatment of capsular contracture, which emphasizes the importance of its prevention.

AIM: To determine the incidence and risk factors of capsular contracture in the era of multidisciplinary breast cancer treatment using modern surgical and therapeutic approaches.

MATERIALS AND METHODS: The following retrospective study included 416 patients after mastectomy with immediate or delayed implant-based breast reconstruction in combination with adjuvant radiation therapy. Features of the surgical intervention, neoadjuvant and/or adjuvant systemic therapy were analyzed to determine the association with the risk of developing capsular contracture.

RESULTS: Capsular contracture during alloplastic reconstructive plastic surgery with adjuvant radiation therapy, according to the literature, is a common complication with a complex and multifactorial pathogenesis. Despite the low incidence of capsular contracture III–IV Baker scale in the present study (7.7%, 32/416), the majority of patients required revision surgery (90.6%, 29/32). There was no correlation between risk of capsular contracture depending on the systemic treatment (z < 1.96).

CONCLUSIONS: The development of capsular contracture was significantly influenced by nipple-sparing mastectomy (13.7%, 22/167; z = 3.25) and the choice of periareolar access during surgery (29.6%, 13/44; z > 1.96). Immediate one-stage reconstructions are associated with a significant number of capsular contractures (15.2%, 24/158; z > 1.96), which statistically significantly depend on the subpectoral location of the endoprosthesis (22.1%, 21/95; z = 2.79) and choice of textured implants (20.8%, 22/106; z = 2.02).

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About the authors

Daria G. Ulrikh

N.N. Petrov National Medical Research Centre of Oncology; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: dashaulrikh@mail.ru
ORCID iD: 0000-0002-1346-933X
SPIN-code: 8231-5996
Russian Federation, Saint Petersburg; Saint Petersburg

Petr V. Krivorotko

N.N. Petrov National Medical Research Centre of Oncology

Email: dr.krivorotko@mail.ru
ORCID iD: 0000-0002-4898-9159
SPIN-code: 2448-7506

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Zhanna V. Bryantseva

N.N. Petrov National Medical Research Centre of Oncology

Email: zhanna-dr@mail.ru
ORCID iD: 0000-0002-9189-6417

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Roman S. Pesotsky

N.N. Petrov National Medical Research Centre of Oncology

Email: shipmeback@gmail.com
ORCID iD: 0000-0002-2573-2211
Russian Federation, Saint Petersburg

Konstantin Yu. Zernov

N.N. Petrov National Medical Research Centre of Oncology

Email: konstantin_zernov@hotmail.com
ORCID iD: 0000-0002-2138-3982
SPIN-code: 9186-5705

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Yana I. Bondarchuk

N.N. Petrov National Medical Research Centre of Oncology

Email: yana_bondarchuk_2015@mail.ru
ORCID iD: 0000-0002-6442-0106
SPIN-code: 9546-3222
Russian Federation, Saint Petersburg

Nikolay S. Amirov

N.N. Petrov National Medical Research Centre of Oncology

Email: amirovn17@gmail.com
ORCID iD: 0000-0002-2421-3284
SPIN-code: 7793-4290
Russian Federation, Saint Petersburg

Diana A. Enaldieva

N.N. Petrov National Medical Research Centre of Oncology

Email: DIANAENALDIEVA932@gmail.com
ORCID iD: 0000-0002-2773-3111
SPIN-code: 2372-3622
Russian Federation, Saint Petersburg

Tengiz T. Tabagua

N.N. Petrov National Medical Research Centre of Oncology

Email: tedo8308@mail.ru
ORCID iD: 0000-0003-1471-9473
SPIN-code: 4466-6316

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Irina A. Akulova

N.N. Petrov National Medical Research Centre of Oncology

Email: akulova_irina91@mail.ru
ORCID iD: 0000-0003-0018-7197
Russian Federation, Saint Petersburg

Valery E. Levchenko

N.N. Petrov National Medical Research Centre of Oncology

Email: levch.ve@gmail.com
ORCID iD: 0009-0003-6597-376X
Russian Federation, Saint Petersburg

Sergey N. Novikov

N.N. Petrov National Medical Research Centre of Oncology, Saint Petersburg

Email: krokon@mail.ru
ORCID iD: 0000-0002-7185-1967
SPIN-code: 7346-0687

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Vladimir F. Semiglazov

N.N. Petrov National Medical Research Centre of Oncology

Email: ssemiglazov@mail.ru
ORCID iD: 0000-0003-0077-9619
SPIN-code: 3874-9539

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the RAS

Russian Federation, Saint Petersburg

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2. Fig. 1. General clinical characteristics of the patients. RT — radiation therapy

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3. Fig. 2. Time of occurrence of capsular contractures after surgery

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