Summary: Capsular contracture is one of the most common complications after breast reconstruction. Surgical treatment is the main option for capsular contracture correction and includes capsulotomy, capsulectomy, and removal/replacement of the affected implant. However, the surgical trauma from reoperation, along with reduced quality of life, in patients with clinically significant capsular contracture has prompted a search for alternative treatment options. The use of the botulinum toxin type A in the treatment of neurological diseases and of keloid scars in aesthetic practice nudged the idea of using the same toxin for the correction of capsular contractures in breast cancer patients. Botulinum toxin type A injection is an easy procedure requiring no anesthesia or inpatient care. The treatment has few side effects. In addition, the injection does not cause sensory loss or dysesthesia. We described a clinical case of the capsular contracture correction using incobotulinumtoxin A. Capsular contracture IV developed 4 months post surgery after long-term lymphorrhea. Radiation therapy was not performed. According to the internal protocol, the patient was advised to undergo incobotulinumtoxin A treatment instead of surgery. Within 1 week after the second injection, all symptoms decreased—specifically, the general shape of the reconstructed breast. Also, the pain syndrome disappeared.

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The article is devoted to the actual topic of breast reconstruction with autologous tissues. The article discusses the key stages in the development of breast reconstructive surgery using free flaps using microsurgical techniques. A flap of the anterior abdominal wall, among other techniques, is the method of choice for breast reconstruction today, also because it allows you to achieve the most "natural" result. The authors compares different variants of autologous flaps, describes the advantages of the DIEP flap in comparison with the TRAM flap. Also, special attention is paid to the choice of breast reconstruction method depending on age, constitutional characteristics and the presence of risk factors such as smoking, diabetes mellitus and excess BMI. Analyzing the advantages of breast reconstruction with autograft flaps, the author concludes that there is a higher quality of life and improved outcomes in these patients than in patients who underwent implant-based reconstruction. Based on the literature review, it was found that breast reconstruction with the help of perforating flaps is still an area of innovation and constant progress: research in this area to date is mainly aimed at reducing the morbidity of the donor area and methods for isolating recipient vessels, shortening the rehabilitation period and developing reproducible reconstruction method.