En bloc Capsulectomy and Implant Exchange, Raleigh ,NC*

This patient had implants placed well over 30 years ago. She had pre-pectoral placement of silicone gel implants. She developed encapsulation over the years and fullness of her upper breast. Mammograms became more difficult as her breast implants were very hard and calcifications were abundant, obscuring the mammogram. She did not want a breast lift although she easily could have had this performed. She did desire replacement of her implants but was hopeful to avoid a complicated procedure with site change or mesh insertion. The patient underwent en bloc capsulectomy which involves removal of the implant capsule and implant material in one piece. It is much safer and easier to do this with subglandular implants. The patient wanted to be very similar in size. Her implants were 340 cc originally and she had replacement with 340 cc implants but they were a lower profile to fit the now widened pocket. She also had lateral capsulorrhaphy to tighten the pocket. Typically we recommend placement in a new pocket such as submuscular to minimize recurrent contracture. However, in her case, if this was performed without a breast lift, her Snoopy Dog deformity would be made worse. Measures to avoid fluid collection and contamination of the implant were made. Drain tubes were used and a Keller funnel utilized. The newer implants now have warranty for capsular contracture so if capsular contracture develops, some costs will be covered by the manufacturer.