title: Capsular grafts and flaps in immediate prosthetic breast reconstruction.
abstract: BACKGROUND
  Patients with previously augmented breasts and a diagnosis of breast cancer who are candidates for immediate prosthetic reconstruction can benefit from capsular tissues used for splinting the position of the pectoralis major muscle.
  
  
  METHODS
  A retrospective clinical review of patients with previously augmented breasts who are undergoing mastectomy and immediate prosthetic reconstruction with capsular tissues was undertaken. The bottom of the periprosthetic capsule was tailored in a novel and versatile fashion as grafts or flaps and used as a sling between the pectoralis major and the inframammary fold.
  
  
  RESULTS
  Of the 21 patients in this study, 19 had unilateral reconstruction, whereas 2 had bilateral reconstructions. Capsular tissues were harvested as free capsular grafts in 15 cases and raised as a capsular flap in the remaining 8 cases. During the follow-up period, complications were detected in 7 patients (1 seroma, 1 infection, 1 hematoma, 1 superficial epidermolysis, 2 cases of rippling, and 1 mild capsular contracture).
  
  
  CONCLUSIONS
  For eligible patients, the use of capsular tissues offers a readily available and cost-effective alternative to acellular dermal matrices with a negligible complication rate. Patient selection is key to ensuring a safe oncologic approach and must be carefully carried out in close collaboration with the breast surgeon.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1st Floor (1181), Buenos Aires, Argentina. horacio.mayer@hospitalitaliano.org.ar.
authors: Horacio F
authors: HF
authors: Mayer
authors: Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1st Floor (1181), Buenos Aires, Argentina.
authors: Hugo D
authors: HD
authors: Loustau
mesh_terms: D000328:Adult; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps