Popcorn capsulorrhaphy instead of capsule removal - is this a good method to use if BII is possible?

Question

I'm having an explant performed in April. My implantation was in June 2022 with under the muscle, 375cc silicone with lift. I do not have contracture or rupture but suspect possible BII. My surgeon is recommending explant but with popcorn/thermal capsulorrhaphy to shrink the capsule. Is this a good method to minimize the capsule without full removal?

Jacob Carlson, MD · Answer

According to the literature available at this time, the most important factor for improvement/resolution of symptoms for patients with Breast Implant Illness is removal of the implant itself. In my most recent review of the literature, at least 80% of patients who had only an implant removal (no capsulectomy) experienced at least some improvement in their symptoms.
Most of the literature says that there is not a statistically significant difference in the improvement/resolution of symptoms based on how much of the capsule is removed. So that seems to suggest that, regardless of whether only part of the capsule or the entire capsule is removed, a majority of patients will notice at least some improvement in their symptoms.
Anecdotally, I like to perform at least a partial capsulectomy so that the breast pocket isn't covered with the capsule lining anymore. I also usually leave drains for 1-2 weeks and have patients wear a compression garment for 6 weeks to reduce the risk of developing a fluid collection within the breast pocket. A popcorn capsulorrhaphy will reduce the surface area of the capsule. My hesitancy to take this approach just comes from a concern that it may lead to a build-up of fluid within the remaining capsule. An implant capsule is already very good at retaining fluid if it is present, so I'm not sure how making the capsule thicker with popcorn capsulorrhaphy (and possibly causing a more intense inflammatory response) will impact that. Shrinking the capsule will definitely reduce the space in which fluid could build up, but I personally prefer to have fresh tissue touching fresh tissue in hopes that the "potential space" is made as small as possible and heals that way.

Gary M. Horndeski, MD · Answer

Popcorn capsulorrhaphy will not be as effective as capsule removal preventing complications BII. If you are afraid that silicone is remaining in the capsule then the capsule must be removed, not just coagulated.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Sean Fisher, MD · Answer

For patients considering explant surgery, many surgeons will look at your clinically scenario to determine if a capsulectomy is indicated. Performing a partial or complete capsulectomy is not without risks, so if there is not evidence of a capsular contracture or other issues related to the capsule itself, many surgeons will note that a total or en bloc capsulectomy is not indicated as the potential risks outweigh the benefits. With a normal appearing capsule, thermal capsulorrhaphy in the setting of explant is a very reasonable proposal. As to considering a total capsulectomy in the setting of concern for BII, there is less of a clear answer for this question. If patients wish to have their capsule removed, most surgeons will note that they are happy to do so, after discussing the associated risks and benefits. 
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

Popcorn capsulorrhaphy instead of capsule removal - is this a good method to use if BII is possible?

Answers (3)

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