A literature review and summary of capsular contracture: An ongoing challenge to breast surgeons and their patients

• A review of the existing literature in regard to breast capsular contracture.
• Presentation, diagnosis, aetiology and assumed causes of contracture discussed.
• Current evidence based management for breast capsular contracture.

Capsular contracture is a significant difficulty where implants are used in both breast augmentation and breast reconstruction surgery. This report reviews the published literature focusing on factors and techniques that reduce the incidence of this complication, as well as evaluating the available treatment options for patients who have developed a contracture.A search of the MEDLINE database for clinical studies involving the understanding, diagnosis and management of capsular contracture was performed, with 106 articles deemed relevant for this review. Our search criteria included observational studies as we wish to discuss and highlight the areas of this condition that have been investigated, and unfortunately there is limited clinical evidence in regard to high quality trials in this field.Risk factors for capsular contracture are multi-factorial, and all surgeons should aim to minimise these as much as possible both intra- and peri-operatively. However, in high risk patients it is not achievable to completely remove these elements. When capsular contracture does develop, there are currently only a limited number of surgical options including capsulotomy, capsulectomy with or without re-implantation, or reconstruction with autologous tissue. These procedures, as well as the original implant surgery, ought to be discussed with patients on an individual basis, taking into account their personal needs and expectations.The future of this complication may lie in the development of pharmaceutical interventions, and recent studies have shown promising results. Although this field requires more research, the effectiveness of some new pharmaceutical approaches, to provide alternative non-surgical options for patients with capsular contracture, can only aid both patients and the breast surgeon.