Endoscopic transaxillary capsulectomy with immediate reimplantation performed as a single-operator outpatient procedure

Abstract

Capsulectomy is a standard treatment for capsular contracture after breast augmentation. Incision via the endoscopic transaxillary approach is generally preferred by Asian women, but relevant literature addressing endoscopic transaxillary capsulectomy is limited. This study described the techniques of endoscopic transaxillary capsulectomy with reimplantation performed as a single-operator outpatient procedure. This retrospective study included patients with diagnosis of capsular contracture underwent endoscopic transaxillary capsulectomy with immediate reimplantation between January 1, 2013 and December 31, 2017. Data regarding history, implant type, operation time, duration of postoperative drainage, and complications were collected and analyzed. A total of 42 patients with a mean age of 36 years were included (11 unilateral and 31 bilateral capsulectomy). Total capsulectomy was performed on four (10%) patients for previous subglandular augmentation, and anterior capsulectomy was performed on 38 (91%) patients for previous submuscular augmentation. Mean sizes of previous and new (or reused) implants were 268 ml (median 283 ml, SD 57) and 317 ml (median 307 ml, SD 49), respectively. Mean operation time for unilateral and bilateral procedures were 4h 15min and 6h 28min, respectively. Postoperatively, mean duration of wound drainage was 10 (SD 3) days. Six (14%) patients experienced complications, including two (5%) patients with seroma, two (5%) with hematoma, one (2%) with infection, and four (10%) with recurrent capsular contracture. The four recurrent cases underwent repeat endoscopic transaxillary capsulectomy. All of the 42 patients had satisfactory clinical and esthetic outcomes. This study demonstrated the feasibility of endoscopic transaxillary capsulectomy with immediate reimplantation performed as an ambulatory surgery by a single surgeon who is in a stable and comfortable sitting position without the aid of a surgical assistant.