title: Is ultracision knife safe and efficient for breast capsulectomy? A preliminary study.
abstract: BACKGROUND
  Silicone breast implants are used to a wide extent in the field of plastic surgery. However, capsular contracture remains a considerable concern. This study aimed to analyze the effectiveness and applicability of an ultracision knife for capsulectomy breast surgery.
  
  
  METHODS
  A prospective, single-center, randomized study was performed in 2009. The inclusion criteria specified female patients 20-80 years of age with capsular contracture (Baker 3-4). Ventral capsulectomy was performed using an ultracision knife on one side and the conventional Metzenbaum-type scissors and surgical knife on the collateral side of the breast. Measurements of the resected capsular ventral fragment, operative time, remaining breast tissue, drainage time, seroma and hematoma formation, visual analog scale pain score, and sensory function of the nipple-areola complex were assessed. In addition, histologic analysis of the resected capsule was performed.
  
  
  RESULTS
  Five patients (median age, 59.2 years) were included in this study with a mean follow-up period of 6 months. Three patients had Baker grade 3 capsular contracture, and two patients had Baker grade 4 capsular contracture. The ultracision knife was associated with a significantly lower pain score, shorter operative time, smaller drainage volume, and shorter drainage time and resulted in a larger amount of remaining breast tissue. Histologic analysis of the resected capsule showed no apoptotic cells in the study group or control group.
  
  
  CONCLUSIONS
  The results suggest that ventral capsulectomy with Baker grade 3 or 4 contracture using the ultracision knife is feasible, safe, and more efficient than blunt dissection and monopolar cutting diathermy and has a short learning curve.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.forename: Pietro G
authors.initials: PG
authors.lastname: di Summa
authors.forename: Dominique
authors.initials: D
authors.lastname: Schaakxs
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rieger
authors.forename: Wassim
authors.initials: W
authors.lastname: Raffoul
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Schaefer
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology / Q000601:surgery; D001941:Breast Diseases / Q000209:etiology* / Q000601:surgery*; D018427:Breast Implants / Q000009:adverse effects; D003286:Contracture / Q000209:etiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000379:methods*; D055815:Young Adult