Case-35498 Gallery

Before and after right capsulotomy and implant exchange performed awake under local anesthesia in a 55-year-old woman. She had developed a small amount of scar tissue around her right breast implant that caused it to sit up a little higher and have a more narrow shape. She had also started to develop pain and discomfort, indicating a Grade IV capsular contracture.

While some patients may not notice such a minor asymmetry, it bothered her - and as a Board-Certified Plastic Surgeon, I am a perfectionist and notice any and all asymmetries! She was relieved that she did not have to go under general anesthesia and did not need a drain.

Numbing medication was injected into her existing inframammary fold scar, and in the areas marked in the last image which shows the surgical plan. Her old implant was removed, and the space internally was reopened under direct vision, using a lighted retractor to see the internal pocket. This procedure is called a capsulotomy (cutting into the internal pocket to open it); while a capsulectomy means surgically removing scar tissue. The last image shows the surgical markings for this breast revision procedure.

In the case of capsular contracture, a small sample of scar tissue is removed (a limited capsulectomy) and it is sent to the Microbiology lab at the hospital to investigate whether bacteria are present, and if so, which antibiotics are best suited to help eradicate this bacteria. For this patient, no bacteria were detected.

A new implant was inserted, as the existing implant is presumably contaminated - capsular contracture is believed to be a result of a bacterial biofilm that develops on the implant, with the body creating circumferential capsular contracture to wall-off any infection and protect the rest of the body from spreading infection.

Follow up photos are shown 1 month after surgery. She resumed implant massage at two weeks postoperatively, and is ready to start scar therapy.