Correlation between Capsular Contracture Rates and Access Incision Location in Vertical Augmentation Mastopexy

BACKGROUND: Plastic surgeons commonly use one of three access incisions to place breast implants during vertical augmentation mastopexy, including inframammary, vertical, and periareolar. It is not known whether there is a correlation between capsular contracture and access incision location. The purpose of this study was to investigate in a single-surgeon series the incidence of capsular contracture associated with access incision locations in silicone vertical augmentation mastopexy. METHODS: Patients undergoing a vertical augmentation mastopexy between 2013 and 2017 were studied retrospectively. All patients underwent a standardized, dual-plane breast augmentation with smooth surface silicone gel implants. Patients were evaluated 1 year postoperatively by the Baker scale. RESULTS: A total of 322 patients met study criteria. Eighty-four had periareolar access, 86 had vertical access, and 152 had inframammary access. There were no differences in patient age or mean implant size between the groups. The capsular contracture rate of the periareolar group was 5.36 percent; in the vertical access group, 3.48 percent; and in the inframammary access group, 1.64 percent. Capsular contracture rates correlated inversely to the distance to the nipple-areola complex, with the periareolar access rates the highest, the vertical access rates intermediate, and the inframammary access rates the lowest. Inframammary incisions were associated with lower capsular contracture rates than periareolar incisions when performed in conjunction with vertical augmentation mastopexy ( p = 0.043). Vertical access capsular contracture rates were intermediate between periareolar and inframammary groups. CONCLUSION: Surgeons should take into consideration the capsular contracture rates associated with access incision location when planning or performing vertical augmentation mastopexy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.