title: Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap.
abstract: BACKGROUND
  Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively.
  
  
  OBJECTIVE
  To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits.
  
  
  METHODS
  Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated.
  
  
  RESULTS
  Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort.
  
  
  CONCLUSIONS
  In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.
authors.affiliation: Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
authors.forename: Brent R
authors.initials: BR
authors.lastname: DeGeorge
authors.affiliation: Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Campbell
keywords: Breast aesthetic subunits; Breast surgery; Capsular flap; Lateral breast border