Understanding Capsular Contracture: Mechanisms, Management, and Patient Outcomes in Implant-based Breast Augmentation and Reconstruction

Background: Capsular contracture (CC) is a frequent complication of implant-based breast augmentation and reconstruction, causing deformity, pain, and reoperation, particularly after mastectomy. CC arises from a multifactorial immune and fibrotic response influenced by patient factors, radiation, implant characteristics, and surgical technique. This review summarized recent data on CC epidemiology, prevention, and treatment. Methods: A narrative review of PubMed and Embase (2020-2024) identified clinical studies on CC after breast augmentation or reconstruction, including trials, cohort studies, case series, and reviews evaluating surgical and adjunctive interventions such as capsulotomy, capsulectomy, and perioperative pharmacological, or material-based strategies. Results: Chronic peri-implant inflammation, bacterial biofilm, and postoperative radiation were consistently implicated in CC pathogenesis, with higher rates in irradiated mastectomy patients. Preventive measures, including antimicrobial pocket irrigation, implant and mesh selection, and atraumatic "no-touch" techniques, were associated with reduced CC in several reports. Pharmacological adjuncts such as leukotriene inhibitors and glucocorticoids showed promising but heterogeneous results. For established CC, capsulotomy is commonly used for mild to moderate disease, whereas complete or partial capsulectomy remains the standard for severe or recurrent cases, often combined with implant exchange and adjunctive measures to limit recurrence. Conclusions: CC remains a major cause of morbidity and revisional surgery after implant-based breast procedures. Contemporary evidence supports a multimodal, patient-specific approach that couples meticulous surgical technique with targeted pharmacological and material-based strategies to prevent and treat CC. Robust prospective studies are needed to define optimal protocols and long-term outcomes.