True Total Capsulectomy
“Capsulectomy” is a procedure I have 24 years’ experience with and countless patients treated. Patients who present with ruptured silicone implants, implant malposition, shape or size issues with their implants, and capsular contracture are treated with various forms of subtotal capsulectomy or total capsulectomy of the anterior surface.
True total capsulectomy takes this procedure one step further by excising the entire formed scar capsule, including the capsule which has formed behind the implant. This must include all capsule attached to the chest wall no matter how challenging this might be. It is this posterior capsule which may present as the most difficult part of the procedure.
In my hands, this True Total Capsulectomy is not necessarily difficult; just time consuming and at times tedious. Much is written about the so called “dangers of total capsulectomy”, but again, for me it is another routine operation.
True total capsulectomy has become ever more important nowadays in the proper management of suspected breast implant associated Anaplastic Large Cell Lymphoma, pre-emptive empiric management of fears of being at risk for this disease, and for suspected illness related to having breast implants in general (sick breast syndromes).
I have been instrumented in our hospital in developing a comprehensive protocol for the subsequent evaluation of the true total capsulectomy tissue specimen.
Pathology and Microbiology evaluations include CD30 (testing for BIA-ALCL), as well as standard tissue pathology. Microbiology evaluation includes gram stain, aerobic and anerobic, as well as AFB, fungal, and viral cultures.
It is up to the patient to determine whether or not they prefer to have an implant replacement as part of their procedure. Some request this and other do not. In the patients who prefer no implant replacement, a decision can be made whether they would benefit from a breast lift procedure and if it is feasible to do this at the same time as True Total Capsulectomy.
If no implant replacement is requested, then I repair the pectoralis muscle and reattach it back to the chest wall ribs in order to restore the functional advantages of a normally positional pectoralis muscle as well as to greatly diminish the possibility of postop seroma (a fluid accumulation in the space previously occupied by the implant). Patients appreciate this greatly
The procedure must be performed under general anesthesia and usually requires the temporary placement of a drain. Pectoralis regional anesthetic blocks are beneficial in the management of discomfort, which is considered by patients to be fleeting in duration and quite minimal in intensity or degree at most. Patients can return to work in days, and fitness endeavors in about a month.
Overall, and in summary, True Total Capsulectomy is a routine procedure that I have many years of experience with. I am sensitive to patients requests and I never try to dissuade a patient form this procedure. We take very seriously patents concerns about their own health and this is why we subject the tissues to comprehensive testing. The overall outcomes are very satisfying to patients, both form a cosmetic and functional standpoint.
I strongly recommend prospective patient contact our office and read our reviews. I look forward to helping you in any way possible.
We take pride in what patients say about us
I came to Dr. Spiro with sub-glandular,encapsulated, 26 year old breast implants. In a word, I came to him with a “mess”. Dr. Spiro was clear, concise and caring in explaining my options and addressing my fears. My initial intention was to take the simple and least expensive approach but after deliberate thought and consideration with the knowledge gained from Dr. Spiro, I opted for the more involved approach. Needless to say, now, just nine months later, the results are nothing less than spectacular! Dr.Spiro and his staff exemplify not only quality,knowledge and experience but also take pride in their craft and care of their patients. I unequivocally recommend Dr.Spiro to anyone considering plastic surgery.