title: The Use of "Precapsular Space" in Secondary Breast Reconstruction.
abstract: BACKGROUND
  Periprosthetic capsule formation is a physiological phenomenon occurring around breast implants. In case of capsular contracture, several surgical techniques are described; among them, total capsulectomy is considered the gold standard, but it is not free of complications. A more conservative procedure is the use of "precapsular space", leaving intact the preexisting capsule. The method presents minor complications and further advantages over total capsulectomy.
  
  
  METHODS
  From November 2010 to June 2014, we treated 92 postmastecttomy patients who previously underwent implant-based reconstruction. They presented implant malposition (bottoming-out, double bubble deformity, upward migration) and different degrees of capsular contracture. The implant was repositioned in a neoprecapsular pocket. Sixty-eight out of 92 patients presented a follow-up longer than 24 months, and they are included in the present study. They were evaluated with a questionnaire 1 month before surgery, at 6 months and 2 years postoperatively. Moreover, two independent plastic surgeons completed the same questionnaire at 6 months and 2 years after surgery.
  
  
  RESULTS
  Mean follow-up is 29 months. Baker III-IV capsular contracture occurred in 9.5 % of the patients, implant malposition in 2.9 % of the cases and no implant displacement rotation was observed. Patient self-assessment preoperatively and postoperatively (at 2 years) revealed improved cosmetic outcomes (p < 0.01). Surgeon assessment correlated with patient self-assessment.
  
  
  CONCLUSIONS
  The use of precapsular space, first described for aesthetic augmentation, is a valid alternative to total capsulectomy for the treatment of capsular contracture or implant malposition, even in the reconstructive field.
  
  
  METHODS
  This journal requires that the 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 www.springer.com/00266 .
authors.affiliation: Breast Unit, Department of Plastic Reconstructive Surgery, Ospedale "S. Maria della Misericordia", University of Udine, Piazzale santa maria della misericordia 15, 33100, Udine, Italy. zingarettin@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Zingaretti
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ulss 9 General Hospital, Treviso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dell'Antonia
authors.affiliation: Breast Unit, Department of Plastic Reconstructive Surgery, Ospedale "S. Maria della Misericordia", University of Udine, Piazzale santa maria della misericordia 15, 33100, Udine, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Biasio
authors.affiliation: Breast Unit, Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Riccio
authors.affiliation: Breast Unit, Department of Plastic Reconstructive Surgery, Ospedale "S. Maria della Misericordia", University of Udine, Piazzale santa maria della misericordia 15, 33100, Udine, Italy.
authors.forename: Pier Camillo
authors.initials: PC
authors.lastname: Parodi
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D020878:Device Removal; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057910:Implant Capsular Contracture / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Breast reconstruction; Capsular contracture; Dislocation; Implant malposition; Secondary breast reconstruction