Correction of Implant Malposition with Capsulorrhaphy: A Retrospective Review and Implementation of Patient Survey

Abstract

Introduction: Aesthetic breast surgery is rapidly evolving and is now the most commonly performed cosmetic surgery; more than 311 000 breast augmentations were performed in 2009. Over the years, the average implant size has increased. It is to be expected that with the increasing number of breast augmentation procedures performed, the rate of implant malposition has increased as well. This problem can be addressed in a systematic way to restore symmetry to the breasts through a surgical procedure consisting of a capsulorrhaphy. Materials and Methods: A retrospective chart review was done from August 2004 through May 2009. All patients who had undergone revisional breast surgery involving capsulorrhaphy were included in the study. Patients were asked to complete a 2-page survey. Intraoperatively, correction of implant malposition involved medial, lateral, and/or inferior capsulorrhaphy. The technique of capsule modification will be described in detail. Results: During the period from August 2004 through May 2009, 30 patients underwent capsulorrhaphy breast surgery for implant malposition. A 2-page survey was completed by 22 of the 30 patients (73%). Average implant size for patients needing capsulorrhaphy surgery was 502.5 mL and 60% were silicone implants. The time from original breast augmentation to revisional surgery was 53.2 months (36.4 months, excluding 2 patient outliers who were >20 years out from their original breast augmentation). The most common problem was inferior or inferolateral implant malposition, which occurred 79% of the time. Bilateral malposition occurred 21% of the time. In all, 91% of patients needed narcotic pain medicine for less than a week, and 59% discontinued narcotic pain medication within 3 days. Patients were taped on average 3.14 weeks. A total of 82% of patients said they had improvement or marked improvement with their current results, and 36% stated that they currently were very symmetric. Follow-up ranged from 3 months to 62 months; mean time from capsulorrhaphy surgery to completion of the patient survey was 22.2 months. In all, 82% of patients stated that if given a choice, they would undergo revisional surgery again. Finally, when asked about overall satisfaction with their experience and results, 86% of patients stated that they were satisfied, 45% were very satisfied, and 14% of patients were unsatisfied. Conclusions: Information collected by the patient survey following our surgical technique shows that the problem of implant malposition following breast augmentation can be addressed and treated by capsulorrhaphy surgery with good aesthetic outcomes and high patient satisfaction. In addition, a recovery with little postoperative discomfort and a decreased need for narcotic pain medicine can be expected. Little information has been published on implant malposition after breast augmentation. More research needs to be dedicated to this common problem.