The Use of “Precapsular Space” in Secondary Breast Reconstruction

Abstract

Periprosthetic capsule formation is a physiological phenomenon occurring around breast implants. In case of capsular contracture, several surgical techniques are described; among them, total capsulectomy is considered the gold standard, but it is not free of complications. A more conservative procedure is the use of "precapsular space", leaving intact the preexisting capsule. The method presents minor complications and further advantages over total capsulectomy. From November 2010 to June 2014, we treated 92 postmastecttomy patients who previously underwent implant-based reconstruction. They presented implant malposition (bottoming-out, double bubble deformity, upward migration) and different degrees of capsular contracture. The implant was repositioned in a neoprecapsular pocket. Sixty-eight out of 92 patients presented a follow-up longer than 24months, and they are included in the present study. They were evaluated with a questionnaire 1month before surgery, at 6months and 2years postoperatively. Moreover, two independent plastic surgeons completed the same questionnaire at 6months and 2years after surgery. Mean follow-up is 29months. Baker III-IV capsular contracture occurred in 9.5% of the patients, implant malposition in 2.9% of the cases and no implant displacement rotation was observed. Patient self-assessment preoperatively and postoperatively (at 2years) revealed improved cosmetic outcomes (p<0.01). Surgeon assessment correlated with patient self-assessment. The use of precapsular space, first described for aesthetic augmentation, is a valid alternative to total capsulectomy for the treatment of capsular contracture or implant malposition, even in the reconstructive field. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .