Dual-plane implant positioning for capsular contracture of the breast in combination with mastopexy.
OBJECTIVE
This study aims at combined surgical therapy options concerning patients with a clinically relevant and long-established capsular contracture following subglandular breast augmentation in a glandular ptotic breast.


METHODS
This is a review of 23 patients with capsular contracture. Three patients had a revision surgery for capsular contracture and implant dislocation before. The mean implant duration in the case of the twenty patients without any previous revision was 96 months. A revision implant has been re-located in a dual-plane position and further corrective surgery was carried out to adapt the glandular ptotic breast. Between 2001 and 2003, a chart review was performed on all patients for capsular contracture and ptotic breast by using the technique presented in this study.


RESULTS
In each case, the operation was performed as a one-stage procedure. The procedure included the following steps: Removal of the implant and total capsulectomy, preparation of an inferior de-epithelialised skin pedicle above the inframammary crease, release of the inferior origins of the pectoralis major muscle, creation of a new implant pocket by continuous connection of the inferior muscle border with the cranial edge of the inferior skin pedicle (dual-plane), adaptation of the soft-tissue/skin envelope by closing the cranial V over the implant coverage, preservation of the areola by creating a cranial or cranial medial pedicle. There was a follow-up for a period of up to 48 months, and any complication that occurred was documented. At follow-up period, all patients who had been implanted with a new implant pocket were free of a clinically relevant capsular contracture.


CONCLUSIONS
In the cases of a severe capsular contracture and glandular-ptotic breasts, we presented the surgical corrections of the parenchyma/skin envelop as a one-stage procedure following the establishment of a new implant pocket.
Siggelkow
Wulf
W
Department of Obstetrics and Gynecology, Johannes-Gutenberg-University Mainz, Langenbeck-Str. 1, 55101, Mainz, Germany. awsiggelkow@web.de
Lebrecht
Antje
A
Kölbl
Heinz
H
Faridi
Andre
A
D001940:Breast / Q000473:pathology / Q000601:surgery*; D018427:Breast Implants / Q000009:adverse effects*; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D011183:Postoperative Complications / Q000601:surgery*; D011391:Prolapse; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation