Acellular Dermal Matrix–Associated Recurrent Capsular Contracture in a Breast Augmentation Patient

Summary: Capsular contracture (CC) is a common complication following breast augmentation. Acellular dermal matrix (ADM) is increasingly used to reduce and treat CC in breast augmentation. However, rare cases of ADM-associated CC can occur. In this case report, we describe a 63-year-old breast augmentation patient who developed significant recurrent CC following subglandular augmentation, capsulectomies, and ADM-assisted revisions. Despite ADM coverage, the patient developed Baker grade 3 CC. Histologic and immunohistochemical analyses were performed on capsular tissue adjacent to visible ADM (study ADM) and on capsule without ADM contact (study capsule), and the results were compared with benign controls. Study ADM demonstrated histologic evidence of ADM resorption and increased fibrotic density. Study capsule exhibited the greatest capsule thickness. Immunohistochemistry revealed significantly elevated macrophages (CD68+, P < 0.0001), pro-inflammatory M1 macrophages (iNOS+, P < 0.05), and T cells (CD3+, P < 0.01) in both study ADM and study capsule compared with controls. Comparison of study ADM to study capsule revealed a higher macrophage burden near ADM (CD68+ P < 0.001, iNOS+ P = 0.6), whereas T cells (CD3+, CD4+, P < 0.05) were reduced. This case illustrates that ADM may paradoxically trigger an inflammatory reaction, resulting in ADM-associated CC despite its intended protective role. The observed immune dysregulation suggests that ADM resorption, in contrast to incorporation, may be a driver of capsule pathology. These findings underscore the need for further research into patient-specific immune responses to ADM and their implications for CC risk.