Capsular contracture in breast reconstruction

UoM administered thesis: Doctor of Medicine

  • Authors:
  • Rebecca Wilson

Abstract

Introduction: In the UK, more than 55000 women are diagnosed with breast cancer each year. There has been a 50% increase in the number of women undergoing immediate breast reconstruction after mastectomy, greater than 85% of these are implant based. One of the most common and unpredictable long-term complications is capsular contracture, occurring in up to 25% of cases. Acellular dermal matrices (ADM), now commonly used in immediate reconstruction, have been associated with reduced rates of capsular contracture but evidence supporting this is limited. Aims: In patients undergoing immediate implant based breast reconstruction with either Stratticeâ„¢ or a submuscular technique, to determine and compare i) the incidence of capsular contracture and rates of revision surgery ii) patient reported outcomes iii) cosmetic outcomes and iv) short-term clinical outcomes. In vitro, to compare the implant capsule at the ADM interface and the native tissue (pectoralis muscle) interface. Methods: A retrospective multicentre cohort study of patients who underwent immediate implant based reconstruction with Stratticeâ„¢ or a submuscular technique between January 2009 and December 2015 across three tertiary UK centres. Clinical examination and tonometry was performed, medical photographs and a comprehensive case note review undertaken. Participants completed the BREAST-Q. In patients undergoing revision surgery after immediate implant based sub pectoral Stratticeâ„¢ reconstruction biopsies were taken from two different areas of the capsule (ADM tissue interface versus pectoral tissue interface) and analysed using histology and immunohistochemistry. Results: The outcomes for 553 Stratticeâ„¢ reconstructions and 242 submuscular reconstructions were compared. Unplanned explantation rate as a complication of primary surgery was 8.5% in the Stratticeâ„¢-assisted group compared to 5.4% in the submuscular. Revision rates were equivalent between the groups (46.7% vs. 41.1%) but there were less revisions performed in the Strattice-assisted group for capsular contracture (5.3% vs. 15.6%, p=

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Original languageEnglish
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Award date31 Dec 2020