What is Capsulotomy?

Fixing the most common complication of breast augmentation

breast implant
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Capsulotomy (pronounced: KAPP-soo-LOTT-uh-mee) is a procedure in which part of the "capsule" of scar tissue surrounding a breast implant is removed or the tissue altered or released in some way. The procedure is performed as a way of attempting to fix the most common complication of breast augmentation surgerycapsular contracture

Capsular contracture occurs when scar tissue forms around breast implants and occurs in 10.6% of breast implant patients.

However, the incidence of contracture developing is lower with the use of textured implants, submuscular placement, and the use of polyurethane coated implants.

The breast may harden, look and feel different, as well as cause discomfort as the tissue tightens around the implant because of the capsular contracture. The most likely reason it happens is because there is a low grade contamination from the body, the breast, or the surgical experience. Antibiotics cannot penetrate the biofilm that now surrounds the implant, and a capsulotomy of the breast is needed. There are two ways it can be done:

Open Capsulotomy

The scar tissue (capsule) is surgically released and/or partially removed through an incision within the breast area. 

Closed Capsulotomy

Vigorous compression is applied from the outside of the breast (no incisions are made) in an attempt to break up the scar tissue and release the contracture of the capsule.

This is not recommended by most doctors and is strongly advised against by manufacturers of breast implants, as there is a risk of implant rupture. In fact, use of this practice voids the warranty on most breast implants. 

Closed capsulotomy is sometimes confused with capsulectomy, another procedure which is designed to improve capsular contracture.

Capsulotomy v. Campsulectomy

These two procedures not only have similar names but treat the same breast augmentation issue. So what's the difference? Capsulectomy is the surgical term for removing the envelope that surrounded your implant. Capsulotomy is the opening up of the area so implants have more room.

Recovery

Postoperative swelling, especially after capsule procedures can last several weeks. If you experience a lump of any kind during this time, visit your surgeon promptly, especially if it increases in size quickly. The lump could be a collection of blood or fluid, or even a reactive lymph node. Either way, seek medical advisement.

Preventing Capsular Contracture, Again

Undergoing another surgery is no fun. There are ways to prevent capsular contracture from happening in the first place. These precautions should be taken after capsulotomy, too, since there is a 50% chance that capsular contracture can reoccur. The number one thing you can do is vigorous massage post-op. There is also some evidence that compression of the breast following surgery may help.

The earlier the better — whatever your pain threshold will allow. 

Sources

Adams WP Jr, Capsular contracture: what is it? What causes it? How can it be prevented and managed? Clin Plast Surg. 2009 Jan;36(1):119-26, vii. doi: 10.1016/j.cps.2008.08.007

Camirand A, Doucet J, Harris J. Breast augmentation: compression — a very important factor in preventing capsular contracture. Plast Reconstr Surg. 1999 Aug;104(2):529-38; discussion 539-41.

Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg. 2015 Sep;42(5):532-43. doi: 10.5999/aps.2015.42.5.532. Epub 2015 Sep 15.

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