BACKGROUND: Although many theories exist, the etiology of capsular contraction (CC) development is still not known. Anatomic location has been suggested as a possible risk factor, but rates of CC development vary between studies, often with conflicting results. This study examines the risk developing CC with subglandular compared to submuscular placement of the breast implant. METHODS: A total of 1,283 studies were identified from December 2003 to December 2013 by PUBMED and MEDLINE searches and a manual search strategy. Two levels of screening resulted in 10 studies suitable for meta-analysis, providing data on a total of 17,520 breast implants. All statistical calculations were performed with Review Manager (RevMan) version 5.2.7. RESULTS: Random-effect (RE) pooled relative risk (RR) and confidence intervals (CI) were calculated for capsular contraction. The risk of developing capsular contraction with subglandular implants was more than 2-fold increased compared to submuscular implants (RE RR 2.18; 95% CI 1.41-3.35; P = 0.0005). The trend was not examined with regards to subfascial placement compared to submuscular or subglandular because more studies are needed to determine this. CONCLUSION: This analysis demonstrated a more than 2-fold increase in the risk of capsular contraction with subglandular compared to submuscular breast implant location. CLINICAL QUESTION: Risk.
BACKGROUND: Although many theories exist, the etiology of capsular contraction (CC) development is still not known. Anatomic location has been suggested as a possible risk factor, but rates of CC development vary between studies, often with conflicting results. This study examines the risk developing CC with subglandular compared to submuscular placement of the breast implant. METHODS: A total of 1,283 studies were identified from December 2003 to December 2013 by PUBMED and MEDLINE searches and a manual search strategy. Two levels of screening resulted in 10 studies suitable for meta-analysis, providing data on a total of 17,520 breast implants. All statistical calculations were performed with Review Manager (RevMan) version 5.2.7. RESULTS: Random-effect (RE) pooled relative risk (RR) and confidence intervals (CI) were calculated for capsular contraction. The risk of developing capsular contraction with subglandular implants was more than 2-fold increased compared to submuscular implants (RE RR 2.18; 95% CI 1.41-3.35; P = 0.0005). The trend was not examined with regards to subfascial placement compared to submuscular or subglandular because more studies are needed to determine this. CONCLUSION: This analysis demonstrated a more than 2-fold increase in the risk of capsular contraction with subglandular compared to submuscular breast implant location. CLINICAL QUESTION: Risk.