Ultrasound-guided percutaneous injection of triamcinolone acetonide for treating capsular contracture in patients with augmented and reconstructed breast.

Abstract: To evaluate ultrasound (US)-guided treatment of capsular contracture (CC) in patients with reconstructed/augmented breast. Twenty-five patients with grade IV CC were treated with peri-implant US-guided injection of triamcinolone acetonide. Before/after treatment, maximum capsular thickness (MCT) was measured by ultrasound and pain assessed with visual analogue score (pain-VAS). Patients with pain relief at 1 month were considered early responders (ERs). Another injection was performed in patients without pain relief at 1 month (late responders, LRs). One patient (treated with chemo-radiotherapy) experienced severe pain and local reaction after the second injection, requiring surgery. Twenty-four patients had baseline MCT of 1.8 +/- 0.3 mm and pain-VAS of 4.9 +/- 0.5, the baseline MCT of 19 ERs (1.7 +/- 0.2 mm) being significantly lower than that of 5 LRs (2.1 +/- 0.2 mm) (p = 0.030). ERs had significantly reduced MCT and pain-VAS at one (1.1 +/- 0.3 mm; 1.5 +/- 0.5) and 6 months (1.1 +/- 0.2 mm; 0.9 +/- 0.7, respectively) (p < 0.001). At 1 month, LRs had a significantly reduced MCT (1.6 +/- 0.1 mm, p = 0.042) but non-significantly changed pain-VAS (4.7 +/- 0.2); 5 months later, MCT reached 1.0 +/- 0.1 mm, pain-VAS reached 0.8 +/- 0.5 (p < 0.044). Significant correlation between the relative variation of MCT and pain-VAS (1 month/baseline) was found. US-guided injection of triamcinolone acetonide is effective in treating grade IV CC.