Capsular Contracture After Breast Augmentation: A Systematic Review and Meta-Analysis

Capsular contracture is characterized by the formation of a fibrous capsule around a breast implant after an augmentation mammaplasty, and often results in pain, firmness, and implant distortion. The aim of this meta-analysis was to investigate how implant and surgical characteristics affect rates of capsular contracture after breast augmentation. A systematic review and meta-analysis were performed in PubMed MEDLINE, EMBASE (OvidSP), and Cochrane Library. Comparison groups included smooth vs textured implants; subpectoral vs prepectoral implant placement; saline vs silicone implants. Odds ratios (ORs) were calculated for capsular contracture for each of these groups. The inclusion criteria were met in 24 studies. Smooth implants were associated with significantly higher capsular contracture rates compared with textured implants (OR = 2.80, 95% CI, 1.92-4.08). Subpectoral implant placement demonstrated significantly reduced capsular contracture rates compared with prepectoral placement (OR = 0.35, 95% CI, 0.25-0.50). No significant difference in capsular contracture rates was found between silicone and saline (OR = 0.39, 95% CI, 0.02-6.69). This meta-analysis suggests that textured-surface implants are associated with lower capsular contracture rates than smooth implants following breast augmentation. Additionally, subpectoral implant placement was associated with significantly reduced rates of capsular contracture compared with prepectoral placement. There was no significant difference in capsular contracture rates between saline and silicone implants. However, the absence of large, randomized controlled trials included in this study underscores the need for prospective investigation of the relationship between implant and surgical characteristics and postoperative outcomes.