Before and after bilateral total capsulectomy for old ruptured and contracted second generation silicone gel breast implants and implant exchange in a 63-year-old woman.
Her original surgery was performed in 1982. Given our current knowledge, breast implants from the 1970’s and 1980’s (second-generation devices) have most likely broken down, as evidenced by the rock hard circumferential capsular contracture around the devices. This is the body’s way of preventing inflammation from spreading beyond the implant pocket.
A total “en bloc” (removing everything in one piece, as a whole) is only indicated in circumstances such as this, where opening the implant capsule would lead to a messy intraoperative field and more extensive cleanup. En bloc capsulectomy is also only recommended for cases of invasive cancer, not for routine implant removal procedures.
In this case, a long incision was made in her inframammary fold, lengthening her old scar by several inches on each side. The implant and its firm capsule were removed in their entirety and opened on the back table, as seen in the last two set of photos and this video which shows a total capsulectomy and ruptured implant specimen.
The old implant pocket was washed out and the implant space was reopened via a capsulectomy. New smooth round current-generation silicone gel breast implants were placed and kept in the subglandular position. She did not want a lift of her nipples, which would necessitate a new lollipop scar on the breast. She liked that her nipples were a little lower, which is normal for a woman in her sixties!
After surgery, she began implant massage in two weeks and resumed full exercise at six weeks. Follow up photos are shown 7 months after surgery, with soft, mobile breasts and a natural looking result.
See this patient's total en bloc capsulectomy specimen and its contents: Instagram Post
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
