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Physiopathology, Prevention, and Treatment of Capsular Contracture

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Oncoplastic and Reconstructive Breast Surgery

Abstract

Capsular contracture is the formation of a fibrous periprosthetic shell as a foreign body response. The capsule has a trilaminar structure. The inner layer consists of a synovial-type metaplasia from fibrocytes and histiocytes, the intermediate layer of smaller fibrils in a vessel-rich network, and the outer layer of densely packed collagen fibers. Myofibroblasts sit in the outer layer, and the capsule may constrict and cause pain and deformation of the implant. Capsular contracture despite advances in surgical technique and implant devices remains a frequent complication after breast reconstruction (2.8–15.9%) [1, 2]. With the adjunct of radiotherapy, a recognized risk factor, capsular contracture rates of 15–50% have been reported [3–8]. In 20–30%, revision surgery has to be performed because of capsular contracture [9–12]. Capsular contracture, because of the multifactorial and in part still unclear etiology, the impairment of quality of life, and the significant economic impact, is subject of greatest interest in plastic and reconstructive surgery.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Guy’s and St. Thomas Hospital, London, UK

    Alessia M. Lardi & Jian Farhadi

  2. Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland

    Alessia M. Lardi & Jian Farhadi

  3. Centre for Plastic Surgery, Pyramid Clinic at the Lake, Zürich, Switzerland

    Jian Farhadi

Authors
  1. Alessia M. Lardi
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  2. Jian Farhadi
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Correspondence to Jian Farhadi .

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Editors and Affiliations

  1. Our Lady of Grace Hospital, Positivo University, Curitiba, Brazil

    Cicero Urban

  2. Plastic and Reconstructive Division, European Institute of Oncology, Milan, Italy

    Mario Rietjens

  3. Memorial Sloan Kettering Cancer Center, New York, USA

    Mahmoud El-Tamer

  4. Memorial Sloan Kettering Cancer Center, New York, USA

    Virgilio S. Sacchini

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Lardi, A.M., Farhadi, J. (2019). Physiopathology, Prevention, and Treatment of Capsular Contracture. In: Urban, C., Rietjens, M., El-Tamer, M., Sacchini, V.S. (eds) Oncoplastic and Reconstructive Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-62927-8_48

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