Use of the periprosthetic capsule in aesthetic and reconstructive breast surgery: literature review and practical applications.

Abstract

Periprosthetic capsule formation is an inevitable consequence of implant-based breast surgery and has traditionally been regarded as an undesirable outcome because of its association with capsular contracture. Nevertheless, growing surgical experience has highlighted that this biologically active, vascularised, and mechanically resistant tissue may represent a valuable autologous resource in selected reconstructive and aesthetic procedures. This narrative review provides an updated overview of the current literature, summarising the biological rationale for capsule reuse, its surgical applications, potential benefits, and the limitations of the available evidence. Published reports describe the use of the periprosthetic capsule as either a pedicled flap or a free graft in a variety of clinical settings, including implant salvage, pocket reinforcement, correction of implant malposition, inframammary fold reconstruction, management of rippling and contour deformities, and lower pole support. Overall, the available literature suggests that capsule reuse may provide reliable structural support and soft-tissue coverage while reducing the need for heterologous materials or donor-site morbidity in carefully selected patients. No oncologically relevant adverse events directly attributable to capsule reuse have been reported in the published literature to date, although the available evidence remains limited. This review aims to provide surgeons with a practical and comprehensive overview of the current indications, technical considerations, and potential applications of periprosthetic capsule reuse in breast surgery. However, the evidence is based predominantly on case reports and small case series, with heterogeneous indications, surgical techniques, and follow-up. Consequently, definitive conclusions regarding long-term safety and effectiveness cannot yet be drawn, highlighting the need for larger prospective studies.