Capsulorrhaphy for revisionary breast surgery

Despite more than 3 million breast implant surgeries performed to date, the common sequela of implant malposition is a problem to which little attention has been paid in the literature. It can be treated predictably and relatively simply with capsulorrhaphy and mirror-image capsulotomy. Additionally, capsulorrhaphy can be used to reduce the size of the implant pocket when changing to a smaller implant.

Several capsulorrhaphy techniques have emerged that allow a more precise result with less effort. In almost all cases of implant malposition, a mirror-image capsulotomy was performed to decrease the tension on the capsulorrhaphy repair. Silicone gel-filled implants were placed in all cases.

Seventy-five patients underwent capsulorrhaphy for implant malposition or implant size reduction between May 2002 and March 2006. Of these patients, just under half (49%) had an accompanying mastopexy. Excision of capsular tissue and prolonged taping of the breasts were found not to be necessary. Average follow-up was 21 months; no complications were reported.

The current technique of capsulorrhaphy and mirror-image capsulotomy has demonstrated satisfactory improvement in implant malposition, without the need for excision of capsular tissue or prolonged taping. Patients did report that their postoperative discomfort was greater than anticipated.