En Bloc Capsulectomy With Implant Removal and Mastopexy with Fat Grafting, NC*

This is a 66-year-old woman who had prepectoral silicone gel breast implants placed 28 years prior. Over the years, she developed firmness of both breasts with distortion and discomfort of the implants. This was considered a Baker IV encapsulation. The patient had a pacemaker preventing her from having an MRI to confirm implant rupture however she had all the classical findings of rupture, including progressive encapsulation. Breast implants placed in the 1980s and early 90s had a fairly high rate of rupture with an estimated 50% rupture rate at the 10 year mark. When she was evaluated it was strongly felt that the implants were ruptured. Regardless of rupture status, she required implant removal with capsulectomy owing to the severe contracture. She did not want replacement but was concerned about the loose skin and drooping that would occur after explantation. She underwent en bloc capsulectomy with removal of bilateral ruptured implants which were contained within the capsule. The capsules were heavily calcified. She did undergo mastopexy although she had very little tissue left. Some fat grafting was performed just over 130 cc per side. Fat grafting during implant removal with mastopexy can be effective in improving results but is unlikely to ever achieve the volume of the prior implant. The patient was quite pleased with her smaller lifted new breasts. Despite having textured implants she did not have any evidence on pathology of ALCL .