Popcorn Capsulorrhaphy in Revision Aesthetic Breast Surgery

Abstract

Background Control of the pocket in revisional breast surgery can be technically challenging and unpredictable. A capsulorrhaphy technique has been utilized in altering capsules in secondary aesthetic breast surgery. Objectives The authors sought to determine the effectiveness of popcorn capsulorrhaphy in revisional breast surgery. Methods A retrospective chart review of revisional breast cases utilizing popcorn capsulorrhaphy was conducted between September 2015 and August 2017. Only aesthetic breast cases were included. Data were collected for 149 patients. Results One hundred forty-nine patients representing 266 breasts were operated on. The average patient age was 42 years and the mean body mass index was 24.2 kg/m2. The average time from their original surgery to the popcorn capsulorrhaphy secondary procedure was 9.3 years. Indications for capsulorrhaphy included malposition in 163 breasts (61.3%), implant positioning for breast ptosis in 34 breasts (12.8%), pocket adjustment for implant size change in 49 breasts (18.4%), and postexplantation pocket reduction in 20 breasts (7.5%). Of the 266 implants, 145 (54.5%) were smooth, 101 (38%) textured, and 20 (7.5%) were explanted. The average original implant size was 405 cc and the average size placed at the time of capsulorrhaphy was 422 cc. Two hundred thirty-six (88.7%) were in a submuscular pocket and 30 (11.3%) were subglandular. The total number of complications was 39 (14.7%), and 16 (6%) required some type of operative revision. Conclusions Popcorn capsulorrhaphy can provide pocket control and stability with low complication and revision rates. The addition of a mesh or biologic at the time of popcorn capsulorrhaphy can further lower the complication and revision rates. Level of Evidence: 4

Revision Breast Augmentation

“…The rate of recurrence was 5.2% (13 of 246, with 4 of these 13 requiring revisions). 62 In 2001, Voice and Carlsen described the use of a capsular flap to correct implant malposition or to support capsulorrhaphy. Advantages to this technique are that it creates a vascularized sling of tissue that places the suture line away from the maximum weight of the implant.…”

A New Technique for Breast Pocket Adjustment: Argon Beam Thermal Capsulorrhaphy

“…However, these modalities are time-consuming and technically challenging, with unreliable long-term results. 3 The “popcorn capsulorrhaphy” was first described by Randquist and Cohen 4 in 2009, and then modified and adapted by Calobrace et al 3 in 2018. It is a highly efficient technique that utilizes thermal energy to shrink and tighten an oversized breast pocket.…”

“…It is a highly efficient technique that utilizes thermal energy to shrink and tighten an oversized breast pocket. 3 In alloplastic breast reconstruction using expanders and implants, even when the expander is properly placed and fixed with sutures to the thoracic wall, some degree of lateral displacement may occur due to the lateralizing forces of repeated pectoralis contractions. 5 , 6 Adjustment of this laterally overstretched pocket at the stage of expander replacement with a permanent implant is one of the most important elements to a successful breast reconstruction.…”

Bioabsorbable Polydioxanone Mesh for Soft Tissue Reinforcement in Revisional Breast Surgery

“…Proposed solutions to this problem have ranged from gland re-shaping in autologous breast surgery cases, to capsule manipulation, 2 to the use of alloplastic devices such as meshes and dermal matrices 3 , 4 to provide support. Bioabsorbable meshes used in the past have shown suboptimal results over the long term 5 , 6 even when placed by experienced surgeons.…”

“… 7 , 8 As these devices have found widespread use in breast reconstruction scenarios, 9 bioabsorbable mesh is now also gaining acceptance in cosmetic breast surgery. 2 , 10-12 …”