A simple technique to make breast implant capsulectomy easier

摘要

Dear Sir,The main reasons for breast implant revisional surgery are implant ruptures, local complications such as capsular contracture, or a desire to change breast size.1 Whatever the reason, in any secondary surgery it is necessary to deal with the problem of the peri prosthetic capsule.2As a general rule, a complete capsulectomy should be performed when no implant will be reinserted after explantation, when a replacement implant will be inserted in a different tissue plane than the explanted one, or when a pathologic capsule is present. On the other hand there is no need to remove, for example, thin capsules, without calcification, in the submuscular plane. An exception to this is the presence of a ruptured silicone gel-filled implant where maximal removal of the gel can be very difficult without a capsulectomy. Equatorial or radial capsulotomy can be suitable when bigger implants need to be inserted and a wider pocket has to be developed. Partial capsulectomy is indicated when the implants to be removed are placed in a subcutaneous position, very close to the skin, such as in some subglandular augmentations, where the implants become superficial with the passing of time, or in some breast reconstructions. Inadvertent injury or devasculari-zation of the skin may occur when removing these capsules, and it is wiser to leave in place the part adherent to skin.Apart from the proximity to the skin, every capsulectomy must be performed with great care, to leave as thick a coverage of the implant as possible, which is certainly one of the priorities of any primary or secondary breast augmentation.3