TITLE:
Nursing Care and Causative Analysis of Grade IV Capsular Contracture Following Breast Cancer Expander Implantation
AUTHORS:
Rong Chen, Nan Zhang, Huiting Zhang
KEYWORDS:
Breast Cancer, Capsular Contracture, Expander Implantation
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.13 No.1,
November
28,
2023
ABSTRACT: Objective: By
observing the treatment and nursing care of a patient with Grade IV capsular
contracture following breast cancer expander implantation and subsequent Stage
II reconstruction, we aim to analyze the reasons for the formation of capsular
contracture after Stage I expander implantation and prevent its recurrence
following Stage II reconstruction. Methods: In May 2020, the patient
noticed an increase in the size of a breast mass. In August, she underwent
AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving
nipple-areolar subglandular excision + right axillary lymph node dissection +
expander implantation” surgery in November 2020. Radiation therapy began in
January 2021. During radiation therapy, the patient experienced severe breast
hardening, distortion, tenderness, and was diagnosed with Grade IV capsular
contracture. To relieve the capsular contracture, the patient underwent a “contracted
capsule incision and release procedure + removal of the right breast expander +
right breast implantation” surgery in July 2021. Postoperatively, measures were
taken to prevent incision infection, emphasizing aseptic techniques, ensuring
smooth negative pressure drainage, reducing skin flap tension, monitoring skin
flap blood supply, actively preventing subcutaneous effusion and hematoma, and
applying appropriate compression dressings. Results: The patient was
discharged after the removal of the drainage tube. During the postoperative
follow-up at 3 and 6 months, there was no recurrence of capsular contracture,
and the breast appeared full, upright, and relatively soft. There were no
complications such as hematoma, infection, breast implant rupture, breast
sagging, or displacement. The patient had a good outcome without additional
financial or surgical burdens. Conclusion: The occurrence of Grade IV
capsular contracture in the patient is generally related to infection after
Stage I expander implantation, improper compression dressing, excessive saline injection
causing content infiltration, and radiation therapy. Therefore, it is
recommended to enhance the intraoperative and postoperative prophylactic use of
antibiotics after Stage I expander implantation. Intermittent saline injection
after surgery, with the amount of saline gradually increasing rather than
filling all at once, is advisable. This helps the breast tissue gradually adapt
to expansion, reducing the risk of capsular contracture. Postoperatively,
patients should be instructed to wear pressure garments and breast elastic
bandages while intensifying breast monitoring during radiation therapy and
increasing postoperative follow-up.