This procedure abandons an original pocket with capsular contracture and creates a new space at the superior layer for new implants. It is a new augmentation mammoplasty and an advanced endoscopic revision surgery. Because this method does not require capsulotomy or capsulectomy, it not only reduces the risk of bleeding or infection but also eliminates the possibility of unexplained or refractory capsules. It is ideal for those who undergo repeated revisions due to refractory capsular contracture or those who have concerns about previous surgeries. Patients who had contracture due to inadequate postoperative massage after subpectoral implants could also use this method and have implants subfascially placed, thus reducing the burden and risk of postoperative care and increasing the success rate.
The surgery can be performed with a new or the original incision and needs to be assisted with an endoscope throughout the process. Currently, the most common method is to change implants from subpectoral to subfascial placement (for those who suffered capsular contracture after subpectoral implant surgery) or from subfascial to supracapsular/subglandular placement (for those who suffered capsular contracture after subfascial implant placement), also called supracapsular or neo-plane dissection. All these methods do not require capsulotomy or capsulectomy to avoid derivative risks such as bleeding and infection. The existing capsule would naturally fit with the space of removed implants, be gradually absorbed by the human body, and become thinner till it disappears.
This surgery creates new operation space and is free from the interference and influence of existing capsules, thus reducing many postoperative uncertainties or complications. According to Dr. Chuang’s statistics, this method presents with a much higher success rate than traditional surgery such as capsulectomy. However, the disadvantage is the complexity and longer duration of surgery. Surgeons need to be fully competent in operating an endoscope, and patients need to have adequate skin conditions to fully benefit from this procedure. Currently, Dr. Chuang utilizes comprehensive endoscopy through a transaxillary incision for all implant removal and conversion procedures, effectively reducing new scarring that could be caused by traditional periareolar incision.