What are the benefits of having a capsulotomy versus a capsulectomy? Also, is it safe to reuse the same implant? (photo)

Question

1 year post BA. I am scheduled to have a capsulotomy (right breast) and the implant will be reused. I am concerned that the CC will return if the capsule is not completely removed, or if a new implant is no used. Also I feel that both nipples are positioned too low. Is there anything my surgeon can do to raise the position of my nipples when he does my capsulotomy? I have 350 cc High Profile Silicone Gel - Natrelle.

Martin Jugenburg, MD · Answer

Capsulotomy is cutting the capsule in order to release the tight contracted capsule and to allow the tissues to stretch out. Capsulectomy is the excision and removal of the capsule.  And yes, it is safe to reuse the same implant unless it's old and at risk of rupturing.Your nipples do not need to be raised.  As the capsule will be released, your implants will (or should) come down a little and sit better in relation to the nipples so that there is no need to move the nipples themselves.(I would consider revising both breasts to better position your implants)

Thomas A. Mustoe, MD, FACS · Answer

If your implant is faitly soft, and the major problem is implant position which makes.the nipples appear low, then capsulotomies should br adequate.  However if the implants are bard suggesting thickened capsules, then capsulectomy with implant replacement more likely to be succ

Scott W. Harris, MD, FACS · Answer

This is a very complex question you've raised and unfortunately many of us approach it differently. When a patient has a high implant, the next question is... is the breast hard? If it is, then there is a capsular contracture. If it's soft, then it's just simply that there's a high implant that needs to be lowered. Different surgeons handle capsular contracture differently, but I like to do a capsulectomy and a new implant. I hope that helps because it's hard to say much more without examining you.

Jerome Edelstein, MD · Answer

A capsulotomy involves cutting the capsule in order to release the tight contracted capsule to allow the tissues to stretch out. Capsulectomy is the actual removal of the capsule.  It is safe to reuse the same implant, however more recent theories of capsular contracture point to the involvement of bacteria, so many surgeons recommend a new implant be used.Your nipples do not need to be raised.  As the capsule is released, your implants will come down somewhat, making the nipples look like they sit higher on the breast.  All the best.

Brent Birely, MD · Answer

If you are just trying to lower an implant or adjust the pocket, capsulotomy is good. If you have CC, I recommend removing as much of the capsule as possible, at least 1/2. The same implant is usually used, but their is a chance the CC could return with the same implant and minimal removal of the capsule. Regarding the nipples, I feel the implants are slightly high and both should be lowered if you are going to the OR. Therefore capsulotomy on the left and ectomy on the right. If you like the implants where they are, then you can have the nipples lifted, but that would put a scar at least 1/2 way around the edge of the nipples.

Jonathan Weiler, MD · Answer

Difficult to tell via the pics, would tell you OK to use the same implant if not ruptured or exposed, but would tell you that it decreases the likelyhood of a good outcome. I agree that your implant poition is too high and that depends on your PS breast aug technique, I would recommend converting both implants to a dual plane technique to allow for a better breast implant position. Good luck and seek a second opinion if uncomfortable.

Darryl J. Blinski, MD · Answer

Just to be open minded, I think your initial pocket dissection was less than adequate inferiorly thus high riding implants with inferior N/A positioning. Recommendation is to open inferior pockets in capsulotomy technique and re use same implants.

Marc Polecritti, DO · Answer

From your pictures, you have capsular contracture; worse on the right. Capsulotomy or capsulectomy could be performed. Either will be helpful in allowing the implant to sit lower and in better position. The decision to do one vs the other typically depends on in-operative assessment. Specifically, the level of release, thickness of the capsule, etc. You also ought to consider a smaller implant. A smaller implant will stress your tissues less, likely heal in a better position and will potentially fit your frame more appropriately.

Kamran Khoobehi, MD · Answer

I am sorry that your results are not perfect. Based on the before pictures and early and late post picture I would say that your implants placed too high and pectoral is muscle was not released(dual plane). Bilateral CC is rare and physical exam would be helpful to make sure you be treated properly. If the problem is the implant malposition, then you do not need new implants. If you have hard breast and implants do not move , then you have CC and I would recommend bilateral capsule removal (capsulectomy) and use new implants. The most common cause of bilateral CC is biofilm( staph infection) and new implants will decrease risk of recurrence .

Vasdev Rai, MD · Answer

You problem is TOO LARGE AN IMPLANT FOR AVAILABLE BODY SPACE.Since implant is large it is reaching way above your nipples.  This creates the illusion that nipples are low.  If large implant is stuffed in a small space it can not move and forms capsule almost immediately.  Your problem will reoccur after either of these operations.You need capsular release and smaller implant, the implant that fits the available space and does not need to be stuffed in.  Large implant will again project above your nipples and recreate the illusion that nipples are low.

What are the benefits of having a capsulotomy versus a capsulectomy? Also, is it safe to reuse the same implant? (photo)

Answers (11)

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