Purpose: Chest wall irradiation is often considered a relative contraindication to tissue expander breast reconstruction. Modifications of technique during expander removal and permanent implant placement may lead to improved long-term results.

Methods: Of a consecutive series of 115 patients who underwent breast reconstruction with tissue expanders, 28 patients underwent chest wall irradiation. All 28 patients subsequently underwent a near-circumferential capsulotomy at implant exchange to recruit surrounding tissue to cover the permanent implant.

Results: 27 of 28 patients who underwent near-circumferential capsulotomies at implant exchange had a successful breast reconstruction with a smooth saline implant. The average fill volume of the expander was 419 ml +/- 150 ml, while the average fill volume of the permanent implant was 461 +/- 160 ml (p < .0005). One permanent implant was removed at three months due to pain and chest wall tumor recurrence. No other patient has returned in the postoperative period (2-53 months) for complaints of tightness, pain, infection or implant loss.

Conclusions: Near-circumferential capsulotomy is a simple adjunct that acts to recruit local soft tissue to cover a breast reconstruction prosthesis. This simple technique perhaps is one factor that contributes to satisfactory patient outcomes.