Abstract
Reconstructive breast surgery, including the use of silicone endoprostheses after radical mastectomy, is an integral part of the comprehensive treatment of breast cancer patients. One of the serious long‑term complications of reconstructive surgery is capsular contracture (CC).
Purpose of the study. To analyze the literature data on the etiopathogenesis of periprosthetic capsule (PC) defects and the possibilities of reducing the risk of CC after breast reconstructive surgery.
Materials and methods. The literature was searched using PubMed, eLibrary, Cyberleninka databases. The following keywords were used: "breast reconstruction", "capsular contracture", "radiation therapy", "polyurethane", "breast implant", "mesh implant". Original studies, meta‑analyses, randomized controlled trials and systematic reviews were used.
Results. The exact etiology of the development of CC has not yet been established. The main pathogenetic mechanism of CC development is chronic inflammation followed by the formation of capsular fibrosis. Radiation therapy significantly increases the risk of developing CC due to the development of fibrotic changes not only in the PC, but also the occurrence of fibrosis of the pectoralis major muscle. The frequency of CC is higher when using adjuvant radiation therapy, compared with neoadjuvant or no radiation therapy, as well as with dual‑plane reconstruction compared with pre‑pectoral placement of the endoprosthesis. The use of a polyurethane endoprosthesis in simultaneous pre‑pectoral breast reconstruction significantly reduces the risk of developing CC in the case of adjuvant radiation therapy, in comparison with textured endoprostheses. One of the ways to reduce the risk of developing CC in breast cancer can be considered the installation of mesh implants, which contributes to the augmentation of the integumentary tissues and improves the stability of the breast endoprosthesis in conditions of tissue deficiency.
Conclusion. Simultaneous pre‑pectoral breast reconstruction based on polyurethane endoprosthesis and mesh implants can be considered as a promising technique for reducing the risk of developing CC. There is a positive trend towards reducing the risk of developing CC against the background of adjuvant radiation therapy. Further research is needed related to the reduction of the risk of developing CC.