Background: Capsular contracture is a challenging entity to treat with consistent success. Recently, acellular dermal matrix (ADM) has been shown to be a highly effective therapeutic adjunct, particularly for patients at high-risk for recurrence. Methods: One hundred consecutive patients with Baker III/IV capsular contracture treated with ADM between 2014 and 2024 were included in this retrospective study. ADM was indicated for patients deemed high-risk for failing conventional surgical therapy. Data collected included patient characteristics, primary breast augmentation and revision procedure history, capsular contracture, surgical and nonsurgical treatments, and follow-up findings. Treatment success was defined as Baker II or better. Results: The success rate of capsular contracture treated surgically with ADM was 90 percent. Among the ten patients who failed ADM treatment, eight had silicone implants of whom two had new silicone implant ruptures. Four others had a history of silicone implant rupture prior to treatment with ADM. Some had additional notable characteristics: two resumed smoking, one had a hematoma, one underwent systemic chemotherapy and another breast radiation therapy. Salvage of ADM treatment failures with ultrasound was successful in two out of five patients, both of whom had saline implants. This increased the overall ADM success rate to 92 percent. Conclusions: Adding ADM to conventional surgical techniques has produced the highest success rates in capsular contracture treatment. Given that ADM treatment failure is associated with silicone implant rupture, saline implants are recommended to maximize result longevity. When early ADM treatment failure occurs, ultrasound therapy may salvage those with saline implants.
Hidalgo et al. (2025) studied this question.