COVID-19 Vaccination Status and Capsular Contracture Following Prosthetic Breast Reconstruction: A Retrospective, Multicenter Nested Case-Control Study

BACKGROUND Capsular contracture (CC) is a common long-term complication following prosthetic-based breast reconstruction (PBBR). Seven cases of CC following mRNA vaccination for coronavirus 2019 (COVID-19) are reported in the literature. OBJECTIVES We sought to determine whether receiving the COVID-19 vaccine was associated with CC development following PBBR. METHODS A retrospective, multicenter nested case-control study was performed from January 2014-July 2022 of adult female patients who underwent PBBR with acellular dermal matrix placement. Cases of CC were selected if no adjuvant radiation was received and they presented for follow-up between December of 2020-July 2022. Controls included patients who met inclusion criteria but who did not experience CC in either breast. Patient demographics, breast cancer characteristics, reconstructive surgery details, postoperative complications, and COVID-19 exposure details were analyzed and correlated with CC development. RESULTS Of a total of 230 patients (393 breasts) who received PBBR, 85 patients (135 breasts) met inclusion criteria; of which, 12 patients (19 breasts) developed CC and 73 patients (116 breasts) did not. At the time of median follow up of 18.1 months (n = 85, IQR: 12.2, 33.6), we observed no statistically significant differences between the short- or long-term complications in cases or controls. There were no significant differences in COVID-19 vaccination status, number of vaccine doses, or vaccination type between cases and controls. Vaccination status was not associated with greater odds of CC development (Odds Ratio: 1.44, 95% Confidence Interval: 0.42 to 5.37, p > 0.05). CONCLUSIONS Direct association between CC and COVID-19 vaccination is difficult to prove. Given the known risk of severe COVID-19 infection among immunocompromised patients, those with breast cancer who undergo PBBR should be properly counseled on the benefits and risks of vaccination.