Impact of Scarring Disorders and Surgical Techniques on the Development of Capsular Contracture in Breast Augmentation

Background: Capsular contracture is a common complication following breast augmentation and a major indication for reoperation. While pocket contamination and aberrant inflammatory processes are suspected causes, a definitive etiology has not been identified. This study investigates if other disorders of aberrant scarring such as Dupuytren disease, hypertrophic scars, and keloids are clinically correlated with developing capsular contracture, as well as the use of certain surgical techniques. Methods: A retrospective chart review of patients undergoing breast augmentation at a single institution was conducted. Data were collected on the history of aberrant scarring and use of specific surgical techniques (eg, sizers, Keller Funnel, antibiotic irrigation +/− bacitracin, povidone-iodine). The Fisher exact test was used to assess the statistical significance of patient demographics and surgical technique. Cox regression survival analysis was used to compare the development of capsular contracture between those with and without hypertrophic skin conditions while controlling for patient demographics and surgical factors. Results: A total of 270 patients were identified; 29 patients (10.7%) developed clinically significant capsular contracture within 2 years of surgery. No significant differences were found between the groups regarding the history of Dupuytren disease, hypertrophic scars, or keloids. However, the use of the Keller Funnel was significantly more common in the group without capsular contracture ( P <0.01). The use of sizers, antibiotic irrigation with or without bacitracin, Irrisept, or povidone-iodine showed no significant impact on the incidence of capsular contracture. Conclusion: The use of the Keller Funnel was significantly associated with a lower incidence of capsular contracture, suggesting its benefit in breast augmentation cases. Other factors, such as a history of scarring conditions or the use of different types of irrigation, did not show a significant relationship with the development of capsular contracture. These findings emphasize the importance of the “no touch” surgical technique in reducing the risk of capsular contracture.