Review of closed capsulotomy complications.

Seventy-five closed capsulotomies were reviewed and the degree of capsular contracture graded. The nutcracker technique was employed. In 35 cases, tonometric measurements before and after capsulotomy quantitated the improvement. Complications included inability to rupture the capsule, recurrence of contracture, distortion of breast shape, and in 1 patient, implant rupture. The degree of breast softness after capsulotomy correlated well with tonometry and was inversely proportional to the degree of preexisting capsular contracture. Softness was also proportional to the latency of onset of contracture. Analysis of the results suggests that capsulotomy is best performed in the patient with mild to moderate contracture and is containdicated in patients with severe contracture or breast distortion from previous capsulotomy. The nutcracker technique is advised, and reduction of pressure is urged once the capsular tear is heard. Closed capsulotomy usually, but not always improves breast firmness. It provides the physician with a nonoperative means of coping with an undesirable result.