title: The timing of implant exchange in the development of capsular contracture after breast reconstruction.
abstract: OBJECTIVE
  Capsular contracture is a common complication associated with reconstructive breast surgery. The optimal time interval between the completion of tissue expansion and placement of the permanent implant is arbitrary and incompletely studied in the literature. The aim of the study was to determine whether the time interval between completion of expansion and placement of the permanent implant would affect the incidence of capsular contracture.
  
  
  METHODS
  We conducted a retrospective study of 112 patients with breast cancer, including 140 breasts, who underwent postmastectomy tissue expander placement between 1997 and 2004. All patients underwent replacement of tissue expander with a permanent prosthesis. Data were collected retrospectively, including whether the patient smoked, underwent radiation therapy, had saline or silicone implant reconstruction, required reoperation after tissue expander placement or after permanent implant placement, Baker classification, and the interval between completion of expansion and placement of permanent implant.
  
  
  RESULTS
  We used a logistic regression model to incorporate the predictors of capsular contracture. Keeping all other predictors constant, we found that the time interval between implant exchange had no effect on capsular contracture. The only significant predictor of capsular contracture was whether the patient required a reoperation after the permanent implant was placed (P = .0001).
  
  
  CONCLUSIONS
  Allowing the capsule around a tissue expander to mature does not significantly affect development of capsular contracture. However, a complication that necessitates disrupting the periprosthetic capsule of the permanent implant with an operation significantly increases odds of developing contracture.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA. jenniferweintraubl@juno.com
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Weintraub
authors.forename: David M
authors.initials: DM
authors.lastname: Kahn