Subpectoral and Precapsular Implant Repositioning Technique: Correction of Capsular Contracture and Implant Malposition

BACKGROUND: Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as an obstacle during the corrective procedure to reposition the implant. The ideal treatment of capsular contracture is removal of the capsule and covering the implant with a healthy envelope without scar tissue. However, total capsulectomy in the submuscular space may be difficult, especially if the capsule is firmly attached to the chest wall. This situation may require a highly skilled technique because aggressive capsulectomy could injure the intercostal muscles and vasculature and cause further complications such as pneumothorax. Therefore, the authors have developed a new, less traumatic method of leaving the capsule behind the new implant. METHOD: From February 2001 through February 2009, the authors treated 74 patients (139 breasts) using a subpectoral, precapsular implant repositioning technique. These patients suffered from capsular contracture or implant malposition after submuscular breast augmentation. The technique is composed of three parts. First, a plane was developed between the anterior wall of the capsule and the posterior surface of the pectoralis major muscle using a periareolar or inframammary approach. After removing the previous implant, the anterior wall of the capsule was fully released from the posterior surface of the pectoralis major muscle and fixed to the posterior wall of the capsule which adhered to the chest wall. The new implant was inserted into the developed subpectoral space, anterior to the capsule. RESULTS: The mean age of the patients was 31 years (range = 24-52) and the time between the primary and the secondary augmentation was 42 months (range = 4 months to 12 years). The range for follow-up was from 12 months to 5 years. Median follow-up was 26 months. Postoperative complications included two cases of hematoma but no cases of infection, muscle distortion, or double-bubble deformity. CONCLUSION: This technique is a valid alternative treatment for capsular contracture or malpositioned implant after breast augmentation surgery. It may be less traumatic than the conventional method of total capsulectomy. In addition, this technique reduces the relapse rate of capsular contracture significantly compared to a partial capsulectomy or capsulotomy as the new implant is inserted into a scar tissue-free environment. Good aesthetic results and patient satisfaction was achieved using this method. In our experience, this novel technique is a good alternative method of correcting complications of submuscular implant augmentation.