Reply: Removal of Nasal Silicone Implant and the Impact of Subsequent Capsulectomy : Plastic and Reconstructive Surgery

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Reply: Removal of Nasal Silicone Implant and the Impact of Subsequent Capsulectomy

Kook, Won S. M.D.; Yang, Chae E. M.D.; Lew, Dae H. M.D., Ph.D.

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Plastic and Reconstructive Surgery: July 2020 - Volume 146 - Issue 1 - p 94e-95e
doi: 10.1097/PRS.0000000000006945
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We appreciate the interest in our article1 shown by Drs. Pu and Han and thank them for raising some good questions. All operations were performed at a single center, but the photographic and statistical analyses were performed in cooperation with the Department of Plastic and Reconstructive Surgery and the Department of Biomedical Statistics at Yonsei University College of Medicine (Seoul, Republic of Korea). Statistical analysis was performed by analysis of variance and Kruskal-Wallis method using the R package, version 3.4.3. Results are clear and the difference seems significant even if the study sample is relatively small.

Factors pointed out by Drs. Pu and Han, such as age, sex, personal health status, immune status, and degree of response to a foreign material, may in fact impact on the denaturing process when silicone is still in place.2 If one wants to anticipate the timing, and the degree of denaturing process after rhinoplasty with silicone implant, a multifactorial analysis would be appropriate; however, in this study, the main focus was on whether removing the remnant capsule or not impacts on further contracture in the surgical bed.

The average values of nasal bridge length index and nasolabial angle for each preremoval/postremoval group in fact encompass the cumulative effect caused by multiple factors of individuals, and we do not see the necessity for a multifactorial analysis of each individual. This point is well illustrated in an article by Dr. Swanson, where he reported on the safety and effectiveness of open capsulotomy in avoiding morbidity and cost of a capsulectomy in breast augmentation patients. This article successfully showed the impact of capsulotomy in preventing recurrence in comparison with that of capsulectomy without the use of any multifactorial analysis.3 Another similar report by Wan and Rohrich also showed no difference between capsulectomy versus open capsulotomy in treating capsular contracture in breast augmentation patients without resorting to multifactorial analysis.4

With regard to the comment by Drs. Pu and Han on the subjectivity of what constitutes a “remarkably contracted nose,” we believe there can be some room for subjective judgment. Determining the severity of contracture is a clinical call. The Baker classification grade, which classifies the degree of capsular contracture after breast augmentation, is in fact not a quantification of objective value or mechanical measurement but is based on the surgeon’s physical examination and the patient’s symptoms. This “subjectivity” issue is encountered by many physicians and researchers in the clinical field. Dr. Kim classified the nasal capsular contracture applying the Baker classification.5 Thus, the remarkable contracted nasal appearance in our article corresponds to grade III to IV according to these criteria. However, we do not feel the necessity of assigning grade III to IV as the indication for concomitant capsulectomy. Our study showed that the capsulectomy was more effective in the contracted nasal appearance group, and it has a preventive effect of contracture deformity in grade II as well. More extensive capsulectomy is needed with a high grade of contracture, and a smaller range of capsulectomy can be performed in lower grade contractures.


None of the authors has a financial interest to declare in relation to the content of this communication.


1. Kook WS, Yang CE, Lew DH. Removal of nasal silicone implant and the impact of subsequent capsulectomy. Plast Reconstr Surg. 2019;144:575e–585e.
2. Jung DH, Kim BR, Choi JY, Rho YS, Park HJ, Han WW. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases. Plast Reconstr Surg. 2007;120:1997–2003.
3. Swanson E. Open capsulotomy: An effective but overlooked treatment for capsular contracture after breast augmentation. Plast Reconstr Surg Glob Open 2016;4:e1096.
4. Wan D, Rohrich RJ. Revisiting the management of capsular contracture in breast augmentation: A systematic review. Plast Reconstr Surg. 2016;137:826–841.
5. Kim YK, Shin S, Kang NH, Kim JH. Contracted nose after silicone implantation: A new classification system and treatment algorithm. Arch Plast Surg. 2017;44:59–64.


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