Internal Capsule Elevation (ICE Procedure)

Abstract

The internal capsule elevation (ICE) procedure is a new operation designed to reposition an inferiorly or laterally displaced or misplaced breast implant. The distinct advantage of this procedure is the ease of the operation because it is essentially a suture-free capsulorrhaphy. The premise of this procedure was derived from the simple observation that replacing a deflated saline implant after a significant delay (1 month) required a fairly vigorous dissection to reopen the periphery of the original pocket. This is due to the fact that the peripheral pocket that is no longer kept open by the inflated implant adheres to itself through the body’s normal healing processes. This natural phenomenon may be enhanced by lightly cauterizing in a fractionated pattern, the area of desired closure inferiorly or laterally in an arc like fashion. By opening the opposite superior and/or medial pocket with an electrocautery capsulotomy and minimal blunt dissection, this allows the repositioned implant to be more easily relocated in the more desirable position. Suture capsulorrhaphy is a procedure that requires extreme accuracy in placement of the sutures to avoid dimpling or irregular contours of the inferior and lateral breast. In experienced hands, it can be a very reliable procedure.1-3 In my experience, many patients have presented with misshapen breasts after suture capsulorrhaphy in inexperienced hands. Many of the patients have expressed regret and are displeased with their outcomes. The ICE procedure offers a technically easier alternative for repositioning the minimally inferiorly and or laterally displaced implant as compared with more traditional suture capsulorrhaphy.