Surgical Treatment of Capsular Contracture with Acellular Dermal Matrix: 100 Consecutive Cases.

[BACKGROUND] Capsular contracture is a challenging entity to treat with consistent success. Recently, acellular dermal matrix (ADM) has been shown to be a highly effective therapeutic adjunct, particularly for patients at high risk for recurrence.

[METHODS] A total of 100 consecutive patients with Baker grade III and IV capsular contracture treated with ADM between 2014 and 2024 were included in this retrospective study. ADM was indicated for patients deemed high risk for failure of conventional surgical therapy. Data collected included patient characteristics, primary breast augmentation and revision procedure history, capsular contracture, surgical and nonsurgical treatments, and follow-up findings. Treatment success was defined as Baker grade II or better.

[RESULTS] The success rate of capsular contracture treated surgically with ADM was 90%. Among the 10 patients with ADM treatment failure, 8 had silicone implants, of whom 2 had new silicone implant ruptures. Four others had a history of silicone implant rupture before treatment with ADM. Some had additional notable characteristics: 2 resumed smoking, 1 had a hematoma, 1 underwent systemic chemotherapy, and another underwent breast radiation therapy. Salvage of ADM treatment failures with ultrasound was successful in 2 of 5 patients; both patients had saline implants. This increased the overall ADM success rate to 92%.

[CONCLUSIONS] Adding ADM to conventional surgical techniques has produced the highest success rates in capsular contracture treatment. Given that ADM treatment failure is associated with silicone implant rupture, saline implants are recommended to maximize result longevity. When early ADM treatment failure occurs, ultrasound therapy may salvage those with saline implants.