Objective — to determine the optimal approach for capsular contracture after primary augmentation mammoplasty. Material and methods. There were 92 patients with capsular contracture of various grades by Baker scale after primary mammoplasty. It was observational dynamic study. Duration of the study was 36 months (January 2016 — January 2019). Assessment of the severity of contracture was followed by capsulotomy or capsulectomy. The result of the study was estimated as a percentage of repeated capsulations. Postoperative follow-up period was 18 months. Results. Capsulotomy is advisable for capsular contracture grade 1 and 2 with primary submuscular deployment of the implant. This procedure is followed by favorable outcome without signs of redo encapsulation. Risk of redo encapsulation after capsulotomy is quite high (up to 10%) in the case of primary subglandular deployment of the implant and subsequent contracture grade 1 and 2. Capsulectomy with replacement of smooth-textured implants for coarse-textured ones is effective for capsular contracture grade 3 and 4 regardless primary deployment fashion. Conclusion. Capsulotomy and capsulectomy is advisable for capsular contracture during primary augmentation. A clear indication depending on the grade of capsular contracture and primary deployment of the implant is essential.

Keywords. breast surgery, augmentation mammoplasty, capsular contracture, complications of mammoplasty