Case of the Month – Nipple Sparing Mastectomy Capsular Contracture

I wrote in the February 2011 Blog about Nipple Sparing Mastectomy.  It is a procedure that was previously associated with poor outcomes, especially capsular contracture  (tightening of the scar capsule around the implant).  Surgery to improve these patients’ outcomes is particularly challenging and not everyone can be helped.  The procedure has much better outcomes now secondary to improved patient selection and the use of acellular dermis.  I have current plans with several local General Surgeons to do immediate breast reconstruction post nipple sparing mastectomy.

The June Case of the Month is presented as a reminder of these previous bad outcomes and how far we have come as a specialty in minimizing their occurrence.  The patient is a woman in her 50’s who had nipple sparing mastectomy greater than 20 years ago for fibrocystic changes and breast pain.  Soon thereafter, she had onset of capsular contracture .  She was recently referred for obviously misshapen breasts suggesting silicone implant rupture.  The patient noted that she wished her previous primary care providers had told her that her breasts were not “normal” and had suggested treatment.

The patient had bilateral capsulectomy with implant exchange for new cohesive silicone gel implants (a vastly improved product and approved by the FDA).  She also had placement of acellular dermis in the lower part of the breast to optimize support and minimize recurrent contracture.

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