Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Abstract

Background:The prevailing theory for capsular contracture after breast augmentation is a subclinical capsular infection. A capsulectomy, site change, and implant replacement are recommended. An open capsulotomy leaves the capsule in the patient. Theoretically, such a procedure would be ineffective because it does not remove the infected tissue. Recurrences occurred frequently in women treated in the 1970s when leaky silicone gel implants were in use. Open capsulotomy has not been studied in women implanted with third-generation devices.Methods:Seventy-five consecutive women with Baker III/IV capsular contractures after breast augmentation treated with open capsulotomies between 1996 and 2016 were retrospectively evaluated. The original implants were usually saline-filled (72.2%). Replacements were all smooth and round, and 92.6% were also saline-filled.Results:Seventeen women (22.7%) developed a recurrent capsular contracture. Two patients (2.7%) experienced a second recurrence. Patients with ruptured silicone gel implants (n = 13) had a significantly greater risk of recurrence (P = 0.01). There was no significant difference in recurrence rates comparing patients whose intact implants were reinserted (12.5%) with women whose intact implants were replaced (18.2%). Povidone–iodine irrigation did not affect the recurrence rate. Capsular contracture was corrected with 1 procedure in 77.3% of patients and 2 procedures in 97.3% of patients.Conclusions:Open capsulotomy is a safe and effective treatment that avoids the additional morbidity and cost of a capsulectomy. The findings challenge the infected biofilm theory of capsular contracture. Open capsulotomy deserves reconsideration by plastic surgeons.

Effect of Keller Funnel on the Rate of Capsular Contracture in Periareolar Breast Augmentation

“…Subglandular implant placement is shown to have increased rates of capsular contracture. 33 In both groups A and B for this study, more implants were placed in submuscular pockets (65% and 93% for groups A and B, respectively). Only 1 of the capsular contracture in group A resulted from subglandular placement, whereas none of the reported capsular contractures for group B resulted from subglandular implant placement.…”

“…In a larger study, it was reported that 36% of contractures that will occur within 10 years, will occur in the first 12 months, and that 65% will occur within the first 4 years. 32 , 33 Of the total 166 patients included in this study, 93 patients (56%) were 4 or more years postoperative at the conclusion of data acquisition and follow-up. All the capsular contractures in group A occurred within 4 years of implantation.…”

Overview of Risk Factors and Prevention of Capsular Contracture Following Implant-Based Breast Reconstruction and Cosmetic Surgery: A Systematic Review

“…Surgeons performed open capsulotomy, which does not remove the capsule from the body and reinserts the intact implant, more often in the past. A retrospective study suggests that an open capsulotomy is a safe treatment and there is no significant difference between capsulectomy and open capsulotomy in the CC recurrence rate [45]. However, this study consists of small sample size and does not provide adequate evidence.…”

The Supra-Inframammary Fold Approach to Breast Augmentation: Avoiding a Double Bubble

“…However, there is little scientific justification for these preferences. 42 Although a recent historical-control multi-site retrospective study 43 concludes that a Keller funnel (Keller Medical, Stuart, Fla.) reduces the capsular contracture rate, there were confounding variables and a short (12-month) follow-up period.…”