Breast augmentation: Part II--Adverse capsular contracture.

Although adverse capsular contracture (ACC) following breast augmentation remains an enigmatic phenomenon, significant progress has been made in diminishing its occurrence during the previous surgical generation. Given the rising global frequency of breast augmentation, however, ACC is likely to be with us for the foreseeable future and an understanding of its nature, and particularly prevention, will continue to be of foremost importance as breast augmentation undergoes a paradigm shift from anti-contracture to aesthetic result as the key outcome measure. Whilst clinical research has hitherto been the mainstay of investigation, providing both understanding and practical guidance, further improvements may derive from new developments in the fields of immunology and molecular biology: convergence of these complementary avenues may eventually yield a non-surgical treatment for ACC. This review presents a summary of our extant knowledge, providing evidence where it exists and a consensus view where it does not. It aims at providing a sound comprehension of the underlying aetiopathology that has provoked the measures seen to date and guides selection of the appropriate therapeutic strategy, which will be expanded in a future review.