Autologous Fat Grafting in the Management of Breast Implant-Induced Capsular Contracture

Capsular contracture (CC) is the most common complication following implant-based breast surgery. It results from a dysregulated foreign body response characterized by inflammation and fibrosis. Effective strategies in the management of CC remain limited. Autologous fat grafting (AFG) is a promising alternative to current approaches due to its regenerative and immunomodulatory properties. This review provides an overview of the current understanding of CC pathophysiology and consolidates preclinical and clinical evidence on the influence of AFG on this pathogenic condition. Preclinical studies use both conventional AFG and isolated adipose-derived stem cells to prevent CC. They consistently demonstrate attenuated capsule formation and reduced inflammatory response. Clinical evidence suggests that AFG reduces both the incidence and recurrence of CC. This is also the case in the high-risk setting of previously irradiated breasts. Therefore, AFG may act as more than a purely volumetric reconstructive technique by modulating the foreign body response and improving capsule characteristics. Emerging strategies in implant-based breast surgery include the improvement of fat graft viability as well as immunomodulatory and bioengineering-based approaches. Overall, AFG appears to be feasible and effective in the management of CC. However, standardized protocols and additional long-term outcomes are required to ensure safe implementation in clinical practice.