Implant Exchange and Capsulectomy Reveals Surprises, North Carolina*

Revisional breast surgery can be challenging and often times surprising findings are noted during the surgical procedure. In many cases, operative reports and information about the breast implants are not available . This 57-year-old woman had prior saline breast augmentation In the early 1990s and developed a deflation. She then went to a different physician and had replacement of her implants via a transaxillary approach.. She developed problems after that procedure and always had differences between her breasts. She was told that she had submuscular implants. She developed fullness in the left breast and abnormalities on ultrasound suggestive of a cyst. Prior aspirations were negative for malignancy but the problems persisted and she had asymmetry and fullness of her left breast causing distortion. At surgery, she was found to have the right breast implant actually in the subglandular or prepectoral plane. She wished to have exchange for saline implants so the new implant was placed in the submuscular position. This technique is known as a site change. Her left side was in the submuscular position but the prior capsule from her previous sub-glandular augmentation had formed a cyst and had to be removed from the breast. The pathology was benign. This reinforces the need to remove capsule from a previously placed prepectoral implant at the time of implant exchange. The capsule had continued to form fluid. Total capsulectomy was necessary on both sides.