The Use of Trichloroacetic Acid to Reduce the Recurrence of Capsular Contracture

Abstract

One of the most common complications of breast implant surgery is the occurrence of capsular contracture. The formation of capsular contracture appears to be due to a prolonged inflammatory state within the breast capsule. Despite treating capsular contracture with surgical capsulectomy, the risk of recurrence can be rather high. Recurrence rates have been reported in the range of 18% to 40%. Chemical capsulectomy can also be considered. The use of 90% trichloroacetic acid (TCA) for chemical capsulectomy was described by Blugerman et al for a variety of indications related to implant capsules. Trichloroacetic acid increases adherence of the flaps which reduces seroma and hematoma formation, thus reducing the risk of recurrence of capsular contracture. The premise of the technique we are presenting is the combination of surgical capsulectomy along with chemical capsulectomy in an effort to minimize surgical risk, reduce postoperative morbidity and further reduce the risk of recurrent capsular contracture. After the planned anterior capsulectomy surgery has been performed, the surgical site is prepared for the use of TCA. The TCA is then applied carefully with a cotton tip applicator to the posterior wall and any remaining capsule. A total of 13 patients have been treated at CAMEO Surgery Center since 2018 with this technique. There is no known recurrence from this cohort to date. Capsular contracture is a known complication of breast augmentation surgery that is associated with a high recurrence rate. Adopting both surgical and chemical capsulectomy approaches combined with other documented measures may reduce recurrence rates of capsular contracture while increasing the margin of safety of the procedure.