PubMed · 9727460
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T A Miller. 1998. Capsulectomy.. https://doi.org/10.1097/00006534-199809030-00042
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After breast augmentation, separation of breast tissue from the implant is common, especially in patients with well-formed preoperative breasts. This problem is enhanced to a marked deformity in cases of scar contracture with firm, fixed implants. This paper addresses this problem preoperatively and therapeutically in secondary correction of double-bubble and waterfall deformity. The author classifies and explains double-bubble deformity in patients in whom the implant is below the normal crease, with glandular breast tissue superior and anterior to the implant. In "waterfall" deformity (a term suggested by the author), the glandular breast tissue droops over the implant and is inferior and anterior to the implant. Treatment used consists of opening the breast tissue from its posterior surface using radial incisions to accommodate the implant. This allows the two structures--the breast tissue and the implant-to blend as one unit with satisfactory results. The technique is easy to perform and teach. Complications are similar to those of regular breast augmentation. Strangely, radial incisions have not increased complications, and there have been no cases of seroma or hematoma to date.
Certain patients requesting breast reconstruction may be described as having a high-risk chest wall with regard to implant loss and well-documented high complication rates. Such patients have a combination of one or more of the following: previous chest wall radiotherapy, heavy smoking, and thin, tethered chest wall flaps. If autologous transfer is not appropriate for such patients then reconstruction may be difficult. In this specific patient group the assistance of endoscopy has been used to raise the latissimus dorsi muscle to cover an expander placed within an endoscopically created chest wall pocket. The first 12 consecutive cases using this technique are discussed, showing an expander loss rate of 8% for the primary implant placement.