Capsular contracture is believed to develop following breast augmentation due to chronic inflammation possibly caused by a bacterial biofilm.
Removal of all of the capsule (capsulectomy) is seen by many as the preferred treatment for women wishing to reduce the symptoms and signs of capsular contracture. However a capsulectomy requires additional surgery, morbidity, increasing operating time, and patient discomfort. In some cases it is very difficult to remove the entire capsule especially from the chest wall.
Release of the capsule (capsulotomy) is seen as a lesser procedure. This procedure is however relatively quick with minimal discomfort and gives additional tissue coverage for any subsequent implant.
Recently Dr Swanson has published his experience of capsulotomy as a treatment of capsular contracture. He concluded that “Capsular contracture after a breast augmentation may be safely and effectively treated with an open capsulotomy, reducing patient morbidity and cost associated with alternative treatments.”
Dr Swanson however does describe an increased incidence of capsular contracture in the presence of ruptured or leaking silicone gel implants when using the open capsulotomy technique.
Mr. Ross agrees that all patients wishing to treat capsular contracture with removal and replacement of breast implants should understand the pros and cons of a total / partial capsulectomy and a capsulotomy. If implants are ruptured or leaking preoperatively a total capsulectomy may be considered to be the optimal treatment method. Where implants are intact a partial capulectomy or capsulotomy may be a better choice for patients.
In revisionary breast augmentation Mr. Ross will always send some of the capsule for pathological evaluation and thus theoretically always performs a total / partial capsulectomy. However in the case of partial capsulectomy the extent of removal can be limited so that the morbidity / operative time of a partial capsulectomy is similar to that of a capsulotomy.
In the case of late onset seroma in combination with capsular contracture Mr. Ross advocates removal of the entire capsule along with the implant in the form of an enbloc total capsulectomy.
Like Dr Swanson, Mr. Ross preforms breast augmentation revisionary procedures through an inframammry incision.
The evidence to support the management of capsular contracture is difficult to interpret and patients need to be guided and be empowered to make the decision on which method to choose.
Reference
Swanson E. Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation. Plast Reconstr Surg Glob Open. 2016 Oct 4;4(10):e1096.
