Incision and Capsular Contracture Risk

Abstract

Background Breast implants can be introduced through a variety of incisions, most commonly an inframammary incision, but also a periareolar incision or an axillary incision. Usually, the implant is inserted through the same incision used in performing an augmentation/mastopexy. Some authors use a separate inframammary incision. Capsular contracture is the most common complication of breast augmentation. One theory holds that it is caused by an infected biofilm, prompting surgeons to minimize implant handling, known as the “no touch” technique. This review was undertaken to investigate the relationship, if any, between the access incision and the risk of capsular contracture. Methods An electronic literature search was conducted to identify publications comparing capsular contracture rates by the access incision. Results Ten studies were evaluated. Most were retrospective series. Three were prospective core studies. Some studies reported an increased risk of capsular contracture for a periareolar incision; a similar number did not. One study supported a separate inframammary incision at the time of vertical augmentation/mastopexy. Discussion Bacterial studies in the last decade show that the resident bacteria on the skin surface and within breast tissue are similar. Sophisticated microbiological evaluation of breast capsules reveals that the microbiome relates to the patient, as opposed to a specific bacterial profile for capsular contracture. A review of the statistics used in determining an advantage for a separate incision at the time of vertical augmentation/mastopexy reveals that there is no statistically significant risk reduction when using an additional inframammary incision, which adds an unnecessary scar. Conclusions The access incision at the time of breast augmentation or augmentation/mastopexy is unlikely to affect the capsular contracture risk. There is no need to make a separate incision to insert the implant at the time of augmentation/mastopexy, or to isolate the implant from contact with breast parenchyma. Little evidence supports the “no touch” technique. The etiology of capsular contracture remains unknown.

Peer Review

“… 41 , 42 For example, authors may not disclose large sums paid by Allergan, maker of breast implants, for a study on a Keller funnel. 40 Allergan purchased the Keller funnel, so the payments are relevant to the evaluation of disclosures of conflict. 40 Any payments should be disclosed regardless of their perceived relevance.…”

“… 40 Allergan purchased the Keller funnel, so the payments are relevant to the evaluation of disclosures of conflict. 40 Any payments should be disclosed regardless of their perceived relevance. 41 …”

“…When these authors publish articles, a positive finding is assured 40 . Unfortunately, payments are frequently undisclosed 40–42 despite very clear language during the submission process. Plastic surgeons may decide that their conflict is not relevant 41,42 .…”

“…40 Allergan purchased the Keller funnel, so the payments are relevant to the evaluation of disclosures of conflict. 40 Any payments should be disclosed regardless of their perceived relevance. 41 If an article indicates that the company sponsoring it designed the study, had control, paid for writing services, and was responsible for the images, data, and analysis (including statistics), 13,43,44 it should not be considered for publication.…”

Conflict of Interest and Plastic Surgery Journal Editors

“…31 Examples include acellular dermal matrix, implantable mesh, radiofrequency devices, electromagnetic treatments, cryolipolysis, and even the Allergan Keller funnel (a nylon sleeve for breast implant insertion). 32 Publication bias is endemic. 6 The corporate strategy is always the same-pay plastic surgeons to use the product and publish articles attesting to its effectiveness and safety, and pay them well.…”