Open Access
CC BY 4.0 · Arch Plast Surg 2025; 52(02): 069-075
DOI: 10.1055/a-2505-7591
Breast/Trunk
Original Article

Predictive Factors of Capsular Contracture in Prepectoral Direct-to-Implant Breast Reconstruction and its Surgical Approach

Si Youn Kim 
1   Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Se Won Oh 
1   Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Eun Jung Yang 
1   Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Seung Yong Song 
1   Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Dong Won Lee 
1   Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract

Background Prepectoral direct-to-implant (DTI) is a common implant-based breast reconstruction method used for patients with breast cancer, although patients often present capsular contracture as a common complication. This study aimed to investigate the causes and surgical outcomes of capsular contractures in patients with breast cancer who underwent prepectoral DTI.

Methods The medical records of 392 patients (472 breasts) who underwent prepectoral DTI between August 2019 and July 2022 were retrospectively reviewed. Comparative and multivariate analyses were performed to identify risk factors for capsular contracture. The outcomes of patients who underwent surgical procedures were analyzed.

Results Of the 472 breasts enrolled in the study, 47 (9.9%) showed capsular contracture. Multivariate analysis revealed that patient age, seroma, rippling, and postmastectomy radiotherapy were independent correlating factors for capsular contracture in prepectoral DTI. Partial capsulectomy was performed on 18 breasts with capsular contracture, which resolved in 88.9% of cases. The mean follow-up period was 14.4 months.

Conclusion Age, seroma, rippling, and radiotherapy were independent correlating factors for capsular contracture in prepectoral DTI. Further, partial capsulectomy is recommended as a treatment option to improve results. A better understanding of the causes and surgical outcomes of capsular contracture on prepectoral DTI will help reduce capsular contracture and eventually lead to better outcomes in breast cancer reconstruction.

Keywords

breast reconstruction - implant - capsular contracture

Note

Findings from this paper were presented at the 13th Reconstruction and Research Forum on 11 May 2023 in Gyeongju, Republic of Korea.


Authors' Contributions

As the first author, S.Y.K. contributed to the formal analysis, methodology, validation, and visualization of the study. S.W.O., E.J.Y., and S.Y.S. contributed to data curation, investigation, and resources of the study. As the corresponding author, D.W.L. contributed to the overall supervision, conceptualization, and project administration of the study.


Ethical Approval

This study design was approved by the Hospital Institutional Review Board (IRB approval number 2023-2301-001).


Patient Consent

Among the patients who underwent surgical treatment, informed consents were obtained from participants who agreed to provide pre- and postoperative photographs.




Publication History

Received: 21 December 2023

Accepted: 14 December 2024

Accepted Manuscript online:
19 December 2024

Article published online:
11 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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