Endoscopic CO 2 Laser-Assisted Capsulotomy—A New Therapeutic Method for Correcting Capsular Contracture

Introduction:

Capsular contracture presents as a common and frustrating complication of breast augmentation surgery. Various strategies have been recommended for resolving this problem, including both closed and open techniques. However, morbidity associated with previously described procedures has left the clinician without a fully satisfactory solution. In this retrospective study, we report our experience with the endoscopic laser-assisted capsulotomy and suggest that it provides a safe, effective method of treating capsular contracture while minimizing morbidity.

Materials and Methods:

The endoscopic, laser-assisted capsulotomy is a technique that has been utilized for 10 years by the senior author and is presented here with our experience in 28 consecutive affected breasts treated over a 5- year period. The operation consists of a small periareolar access incision into the capsule space, followed by capsular release utilizing a CO₂ Ultrapulse laser visualized with a 4-mm endoscope and specialized sleeve developed by the senior author. In this retrospective study, each patient was assessed by the senior author both pre- and postoperatively. Capsular contracture was graded according to Baker's classification method. Postoperative complications and their respective frequencies were also noted.

Results:

Of the 11 patients that initially presented with a Baker score of IV, 9 patients (82%) achieved an acceptable result after laser-assisted endoscopic capsulotomy. One patient (9%) had a final Baker score of III, but was pleased with the result and did not seek further treatment. One patient saw no change in Baker score and underwent a second endoscopic capsulotomy. A final Baker score of I was then achieved.

Of the 16 patients that began with a Baker score of III, 15 (94%) achieved an acceptable result. One patient (6%) saw no change in Baker score but elected to forego further treatment.

One patient that presented with an objectionable Baker grade II contracture achieved a Baker score of I following treatment.

Complications noted included: intraoperative bleeding requiring drain placement in 3 patients, scar hypopigmentation in 1 patient, superficial skin infection in 1 patient that responded to oral antibiotics, and asymmetry between the operated and unoperated breast in 2 patients that did not require correction. Late-term complications included: 4 patients presented with recurrent capsule formation. All underwent a second capsulotomy procedure with acceptable results.

Conclusion:

To our knowledge, this is the first report of use of the CO₂ Ultrapulse laser for this purpose. The capsuloscope sleeve used was developed by the senior author. The technique was effective in correcting capsular contracture, while minimizing complications, scarring, and patient morbidity.