Severe Capsular Contracture Treated with En Bloc Capsulectomy in Raleigh, NC*

This is a 62-year-old woman who had subglandular saline implants placed 30 years ago. She developed severe capsular contracture but never thought there was much she could do about it. She had 300 cc McGhan textured saline implants which have a somewhat higher association with ALCL- a breast implant associated lymphoma. She did not have symptoms or signs of that disease but clearly wanted to remove her implants and wished to have new implants. She had evidence of Baker IV encapsulation which involves distorted, hardened and painful capsules. She underwent an en bloc capsulectomy by Dr. Lyle with placement of new smooth walled silicone gel Sientra 455 cc implants. She had the implants placed in the subpectoral position with a piece of Strattice acellular dermal matrix on the lower aspect of the breast. At surgery her implants were heavily encapsulated with calcified scar tissue and the implants had heavy load of calcium throughout the textured surface. Test results did not show any evidence of malignancy or ALCL. She has done very well now 3 months postop with no evidence of early contracture with excellent implant position with soft more natural-appearing breasts. En bloc capsulectomy is a procedure typically performed when implants are heavily encapsulated and might be ruptured, may harbor infection or ALCL. It entails removal of the implant and surrounding tissue in one piece. This procedure is not always necessary when capsule removal is indicated