Breast

Breast Implant Capsulectomy

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Some women who undergo breast augmentation develop scar tissue around their implants which can cause firmness and/or distortion. Although this is less common with modern techniques and implants, it nonetheless does occur.

Additionally, some women with silicone gel breast implants sustain rupture of their implants, either following significant trauma, or through ordinary wear and tear. Older implants, particularly those inserted before 1992, were particularly prone to rupture and leaking. Rupture may be detected by a change in appearance or texture of the breast, abnormalities detected on mammogram or ultrasound, or, most definitively, by breast MRI.

Patients considering a breast capsulectomy and implant removal for these reasons are seen in consultation with Dr. Casso. A general medical and surgical history is elicited, and examination is performed.

In cases of silicone implant rupture, removal of the implant and associated scar tissue is indicated.

Patients with capsular contracture not related to implant rupture may also benefit from capsulectomy.

Patients are then counseled regarding additional surgical options. These options include:

1. No further surgery. In this case the breast will be smaller and saggier than before.

2. Re-augmentation with saline or silicone breast implants. Modern silicone implants are more cohesive and less susceptible to rupture than older gel implants.

3. Lifting of the breasts. This procedure (mastopexy) allows for reshaping of the (smaller) breast without using an implant. This is a good choice for patients with at least a modest amount of breast tissue, although it may be impossible to achieve significant volume fill in the upper portion of the breast.

4. Lifting and re-augmenting the breasts with saline or silicone implants. This procedure allows for maximal flexibility in accomplishing the size and shape goals for patients. Scarring includes generally a circular scar around the areola, vertical scar down to the crease, and a scar within the crease. Smokers are at significantly higher risk of complications with lifting surgery and are counseled to avoid contact with any nicotine products for several weeks prior to surgery.

Appropriate candidates for this procedure are women in good general health who previously had breast augmentation and who has developed fibrous capsular contracture of the breasts, or who have suffered rupture of a silicone gel implant.

This procedure is performed by Dr. Casso under general anesthesia at Houston Methodist St. John Hospital. While this procedure is sometimes performed under local anesthesia in outpatient facilities and doctors’ offices, Dr. Casso recommends general anesthesia at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

Surgery takes between one and four hours, depending on its extent. Often, a drain is inserted to prevent fluid accumulation. Patients typically go home the day of surgery. Pain is generally moderate, and controlled with oral pain medication.

Patients are generally seen at Dr. Casso’s office the following day, where dressings are changed. A light cami bra is provided, and patients are allowed to shower thereafter. Drains are usually removed within a few days. Sutures are removed within 10 days. Most patients may return to light activities within about a week. Vigorous exercise is discouraged for about a month.

While most patients experience substantial improvement, recurrent capsular contracture may be a problem for some patients who undergo reinsertion of implants.