Incidence and Preoperative Risk Factors for Major Complications After Capsulectomy: Analysis of 3048 Patients

• Published in: Aesthetic surgery journal Vol. 42; no. 6; pp. 603 - 612
• Main Authors: Afshari, Ashkan, Nguyen, Lyly, Glassman, Gabriella E, Perdikis, Galen, Grotting, James C, Higdon, Kent K
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 18-05-2022
• Subjects: Hematoma; Humans; Incidence; Mammaplasty - adverse effects; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Reoperation - adverse effects; Retrospective Studies; Risk Factors
• ISSN: 1090-820X; 1527-330X
• DOI: 10.1093/asj/sjac004

Abstract
Background
Although there are many indications for periprosthetic breast capsulectomy, heightened public attention surrounding breast implant illness has resulted in increased rates of capsulectomy.
Objectives
This study aimed to identify the incidence of major complications and risk factors associated with capsulectomy.
Methods
From an examination of a prospectively enrolled cosmetic surgery insurance database, CosmetAssure (Birmingham, AL), patients undergoing capsulectomy between January 2, 2017 and July 31, 2019 were identified. Outcomes measured included the occurrence of and risk factors for major complication(s) necessitating an emergency department visit, hospitalization, or reoperation within 45 postoperative days.
Results
Among 76,128 patients evaluated, 3048 (4.0%) underwent capsulectomy. There was a significant increase in number of capsulectomies following January 6, 2019 (2.7/day vs 5.2/day, P < 0.05). Capsulectomy patients were more likely to have any complication and specifically hematoma than those undergoing breast implant removal or replacement without capsulectomy (2.8% vs 1.9% and 1.6% vs 0.9%, respectively, P < 0.05). Eighty-four (2.8%) developed at least 1 complication. The most common complications included hematoma (1.6%) followed by infection (0.5%). American Society of Anesthesiologists Class III/IV was an independent risk factor for any complication and BMI ≥30 kg/m2 and office-based surgical suites were risk factors for infection.
Conclusions
A growing number of capsulectomies are being performed. The most common major complication is hematoma. Patients undergoing capsulectomy experience a higher complication rate than those undergoing breast implant removal or replacement without capsulectomy. Patients should be counseled regarding the potential for major complications.
Level of Evidence: 2