Endoscopic CO2 Laser-Assisted Capsulotomy (Minimally Invasive Method for Treatment of Capsular Contracture)

Abstract

Introduction: Capsular contracture is a common problem faced by cosmetic/plastic surgeons and their patients. This retrospective study looks at the effectiveness of and overall patient satisfaction with endoscopic laser-assisted capsulotomy and suggests it is a safe and effective method of treating capsular contracture while minimizing morbidity and scarring and allowing patients to return to their daily activities almost immediately. Materials and Methods: The authors present their experience with 56 patients over a 7-year period. The operation is performed through a small (5–7 mm) periareolar access incision into the capsule, followed by horizontal and radial release of the capsular contracture using a CO2 laser visualized with a 4-mm endoscope with a specialized sleeve designed and built by the senior surgeon. Each patient was assessed preoperatively and postoperatively. Capsular contracture was graded based on Baker's classification method. The procedure was performed on patients with silicone and saline implants. Postoperative complications and patient satisfaction were noted. Results: Of 56 patients in the study, 6 (10.7%) were excluded: 2 had prior radiation therapy, 1 had reconstructive breast surgery for cancer prior to having the implant put in, 2 had a deflation 3 months postprocedure, and 1 had the procedure to treat an implant that had not adequately settled. Many of the patients had been previously treated elsewhere 1 or more times with recurrent capsule formation. One of the 50 patients (2%) presented with Baker II capsular contracture but was lost to follow-up. According to the chart review, the patient was happy with the results postprocedure, and Baker I score was achieved. Thirty-six of 50 patients (72%) presented initially with a Baker III capsular contracture, and of these, 20 (55%) were lost to follow-up, and thus long-term results of the procedure could not accurately be established. Of 16 patients with long-term follow-up, 6 (38%) achieved a score of Baker I and were pleased with the results. Ten patients (62%) experienced improvement initially but recurred shortly after (2–6 months). Thirteen of 50 patients (26%) presented initially with a Baker IV capsular contracture of which 7 (54%) were lost to long-term follow-up, and long-term results could not accurately be established. Two of 6 patients (34%) followed long term achieved a score of Baker I and were pleased with the results. Four patients (66%) recurred shortly after the procedure (2–6 months). Complications included 1 infection postprocedure requiring removal of the implant (in the patient excluded from the study) and 2 drain placements (both patients were lost to follow-up). The mean follow-up was 21 months.