Breast Surgery Revision

Capsulectomy vs. Capsulotomy

Capsulectomy

While occurring in only a small percentage of breast augmentations, capsular contracture remains the most troubling complication of augmentation mammoplasty. Regardless of debates over how to reduce the potential for its development at all, breast surgery revision remains best approach for treatment. When considering revision surgery, there are two approaches that may be taken: a capsulectomy or a capsulotomy. What’s the difference, and when is one preferred over the other?

Gauging the Severity of Capsular Contracture

Capsulectomy and a capsulotomy are both types of breast surgery revision for correction of capsular contracture; determining which one should be used is based on the Baker scale:

  • Grade I – This is the most minor form of capsular contracture; the breast looks and feels normal.
  • Grade II – While the breast may feel slightly firmer than usual, there is no discomfort and the appearance is still normal.
  • Grade III – The breast is firmer than normal and visibly distorted; the implant may look displaced, or the breast may look unnaturally round.
  • Grade IV – Symptoms of Grade III capsular contracture are more pronounced; the breast is not only hard to the touch, but is typically painful as well.

Surgery is indicated for Grade III and Grade IV.

For Grade III capsular contracture, a capsulotomy is typical. The scar tissue capsule is advanced enough to put pressure on the implant, changing its profile. A capsulotomy releases the scar tissue to allow proper implant settling and expansion again, relieving the symptoms.

Grade IV capsular contracture requires a capsulectomy, or full removal of the scar tissue capsule, which by this point is thick to the point of calcification. Full removal of the capsule restores a soft texture to the breast while relieving painful symptoms of capsular contracture.

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