Decoding fibrotic encapsulation in plastic surgery implants: From biological mechanisms to precision interventions...

Mitigating fibrotic encapsulation around implants is critical to ensuring the long-term success of implant-based procedures in plastic surgery. Fibrous capsule formation is a pathological foreign body reaction (FBR) that not only causes capsular contracture and implant failure but also creates a permissive microenvironment for bacterial colonization, thereby increasing the risk of infection. These adverse outcomes may ultimately necessitate implant removal or replacement, significantly compromising surgical results and patient satisfaction. Therefore, a thorough understanding of the mechanisms underlying capsule formation and the development of effective preventive strategies is essential for improving clinical outcomes. This review summarizes current insights into the pathogenesis of plastic surgery implant-associated capsule formation and systematically examines recent advances in intervention strategies. These approaches span four key domains: surface modification of implant materials, pharmacological interventions, bioactive therapies, and intraoperative optimizations and postoperative adjunctive measures. Special emphasis is placed on emerging technologies, novel biomaterials, and therapeutic targets, highlighting their potential in developing innovative solutions. Despite encouraging progress, significant challenges remain in terms of mechanistic clarity, clinical translation, and personalized treatment. Finally, the review proposes future directions focused on interdisciplinary integration, the development of precision therapeutic strategies, and long-term clinical validation-aiming to facilitate personalized and effective prevention of fibrotic encapsulation in plastic surgery implants and to support their widespread clinical application.