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Plane Change Vs Capsulotomy: A Comparison of Treatments for Capsular Contraction in Breast Augmentation Using the Subfascial Plane

  • Original Article
  • Breast Surgery
  • Published:
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Abstract

Background

The management of capsular contraction following breast augmentation has numerous, often conflicting potential treatment protocols, each designed to reduce the incidence of further recurrence. The use of the subfascial plane has not been investigated as an alternative to other treatment options.

Objectives

To examine the outcomes from patients presenting with recurrent capsular contraction after being treated for the first capsule by placement of an implant into the subfascial (SF) plane.

Methods

Retrospective analysis of 111 case notes of patients who presented with capsular contraction. 65 had undergone SF augmentation, 17 submuscular (SM) and 29 subglandular (SG) placement of implant at the primary procedure. At a secondary procedure, those with SF implants underwent open capsulotomy and those with SM and SG implants underwent a change in plane to SF.

Results

There is a significant difference in the proportion of patients that developed a capsule following the second surgery between the groups that had undergone capsulotomy (SF = 16.9%) or plane change (SM = 47% and SG = 37.9%, X2 (2,111) = 8.6, P =  0.02). When recurrence at the same site was examined, there was also a significant difference between the groups (X2 (2111) = 10.7, P < 0.01). A ruptured implant significantly increased the incidence of further capsular contraction when in the SG plane (X2 (2,29) = 12.1, P < 0.01).

Conclusions

In the absence of implant rupture, changing the plane of an implant to a SF position at revision surgery does not reduce the incidence of subsequent capsular contracture compared with open capsulotomy. Open capsulotomy is a reasonable choice following recurrence of capsular contraction following initial SF placement.

Level of Evidence IV

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References

  1. Wan D, Rohrich RJ (2016) Revisiting the management of capsular contracture in breast augmentation: a systematic review. Plast Reconstr Surg 137(3):826–841

    Article  CAS  Google Scholar 

  2. Adams WP Jr (2009) Capsular contracture: What is it? What causes it? How can it be prevented and managed? Clin Plast Surg 36(1):119–126

    Article  Google Scholar 

  3. Chong SJ, Deva AK (2015) Understanding the etiology and prevention of capsular contracture: translating science into practice. Clin Plast Surg 42(4):427–436

    Article  Google Scholar 

  4. Hidalgo DA, Sinno S (2016) Current trends and controversies in breast augmentation. Plast Reconstr Surg 137(4):1142–1150

    Article  CAS  Google Scholar 

  5. Ajdic D, Zoghbi Y, Gerth D, Panthaki ZJ, Thaller S (2016) The relationship of bacterial biofilms and capsular contracture in breast implants. Aesthet Surg J 36(3):297–309

    Article  Google Scholar 

  6. Brown T (2012) Subfascial breast augmentation: is there any advantage over the submammary plane? Aesthet Plast Surg. 36(3):566–569

    Article  Google Scholar 

  7. Miller T (1998) Capsulectomy. Plast Reconstr Surg Reconstr Surg 102:882–883

    Article  CAS  Google Scholar 

  8. Young VL (1998) Guidelines and indications for breast implant capsulectomy. Plast Reconstr Surg 102(3) 884–91. Discussion 892–4

  9. Spear SL (1993) Capsulotomy, capsulectomy, and implantectomy. Plast Reconstr Surg 92(2):323–324

    Article  CAS  Google Scholar 

  10. Swanson E (2016) Open capsulotomy: an effective but overlooked treatment for capsular contracture after breast augmentation. Plast Reconstr Surg Glob Open 4(10):e1096

    Article  Google Scholar 

  11. Lee HK, Jin US, Lee YH (2011) Subpectoral and precapsular implant repositioning technique: correction of capsular contracture and implant malposition. Aesthet Plast Surg 35(6):1126–1132

    Article  Google Scholar 

  12. Mladick RA (1977) Treatment of the firm augmented breast by capsular stripping and inflatable implant exchange. Plast Reconstr Surg 60(5):720–724

    Article  CAS  Google Scholar 

  13. Maxwell GP, Birchenough SA, Gabriel A (2009) Efficacy of neopectoral pocket in revisionary breast surgery. Aesthet Surg J 29(5):379–385

    Article  Google Scholar 

  14. Castello MF, Lazzeri D, Silvestri A, Agostini T, Pascone C, Marcelli C, Gigliotti D, D’Aniello C, Gasparotti M (2011) Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment. Aesthet Plast Surg 35(5):828–838

    Article  Google Scholar 

  15. Baran CN, Peker F, Ortak T, Sensoz O, Baran NK (2001) A different strategy in the surgical treatment of capsular contracture: leave capsule intact. Aesthet Plast Surg 25(6):427–431

    Article  CAS  Google Scholar 

  16. Xue H, Lee SY (2011) Correction of capsular contracture by insertion of a breast prosthesis anterior to the original capsule and preservation of the contracted capsule: technique and outcomes. Aesthet Plast Surg 35(6):1056–1060

    Article  Google Scholar 

  17. Spear SL, Carter ME, Ganz JC (2003) The correction of capsular contracture by conversion to dual-plane positioning: technique and outcomes. Plast Reconstr Surg 112(2):456–466

    Article  Google Scholar 

  18. Lesavoy MA, Trussler AP, Dickinson BP (2010) Difficulties with subpectoral augmentation mammaplasty and its correction: the role of subglandular site change in revision aesthetic breast surgery. Plast Reconstr Surg 125(1):363–371

    Article  CAS  Google Scholar 

  19. Moufarrege R, Beauregard G, Bosse JP, Papillon J, Perras C (1987) Outcome of mammary capsulotomies. Ann Plast Surg 19(1):62–64

    Article  CAS  Google Scholar 

  20. Hipps CJ, Raju R, Straith RE (1978) Influence of some operative and postoperative factors on capsular contracture around breast prostheses. Plast Reconstr Surg 61(3):384–389

    Article  CAS  Google Scholar 

  21. Sugimoto T (1982) Open capsulotomy for capsular contracture: a new procedure for the prevention of recurrence. Aesthet Plast Surg 6(4):225–230

    Article  CAS  Google Scholar 

  22. Herman S (1984) The même implant. Plast Reconstr Surg 73(3):411–414

    Article  CAS  Google Scholar 

  23. Melmed EP (1990) Treatment of breast contractures with open capsulotomy and replacement of gel prostheses with polyurethane-covered implants. Plast Reconstr Surg. 86(2):270–274

    Article  CAS  Google Scholar 

  24. Brown T, Brown S, Murphy T (2017) Breast durometer (mammometer): a novel device for measuring soft-tissue firmness and its application in cosmetic breast surgery. Aesthet Plast Surg. 41(2):265–274. https://doi.org/10.1007/s00266-017-0783-5

    Article  Google Scholar 

  25. Murphy T, Brown S, Brown T (2020) A durometer (mammometer) for objective measurement capsular contraction following breast implant surgery. Am J Cosmet Surg. https://doi.org/10.1177/0748806820925722

    Article  Google Scholar 

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    Tim Brown

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Patients provided written consent to the study under the guiding principles outlined in the WMA Declaration of HELSINKI concerning ethical principles for medical research involving human subjects.

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Brown, T. Plane Change Vs Capsulotomy: A Comparison of Treatments for Capsular Contraction in Breast Augmentation Using the Subfascial Plane. Aesth Plast Surg 45, 845–850 (2021). https://doi.org/10.1007/s00266-020-02010-8

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  • DOI: https://doi.org/10.1007/s00266-020-02010-8

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