Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

Abstract

Background: Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. Methods: A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. Results: Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0e3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4e16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1e15.7) and 15.8% (95% CI: 4.1e15.7) [p ¼ 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR ¼ 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR ¼ 0.3, p ¼ 0.003). Conclusions: After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto-Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).

Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy—A deeper insight considering surgical and patient-reported outcomes

“…We could show that IBR patients suffered more often from major complication (30.6% vs. 8.3%) including major CC (25%), implant dislocation (8.3%), or major infection (1.4%) leading to an implant exchange once, twice, or more often (30.6%). CC rates are in line with the current literature suggesting varying rates of CC after IBR between 10% and 45% ( 24 , 25 ) depending on irradiation of the breast, type of implant, and surgical technique ( 25 ). Since we had a significant difference concerning the time-span of follow-up (IBR: 27.1 ± 9.3 vs. ABR: 34.9 ± 20.5), we must assume that rates of CC with the need of implant exchange in our study cohort are going to increase even more in the future ( 26 ), whereas in ABR, no further major complication have to be expected ( 26 ).…”

DTI prepectoral breast reconstruction with implants: texture vs polyurethane

“…И, именно по этому показателю ПИ продемонстрировали несомненное преимущество, снизив частоту ее развития почти в 2 раза. К аналогичным выводам приходят и другие авторы [12,13]. В целом потеря импланта была в 7 случаях.…”

“…привел результаты собственного наблюдения использования имплантов с полиуре-тановым покрытием (ПИ) без дополнительного укрытия, продемонстрировав полную безопасность данной методики, хотя при небольшой длительности наблюдения (медиана 4 мес) [7]. Также, в ходе ретроспективного исследования, проведенного на базе Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy с 2013 по 2018 г., при детальном сравнении одномоментной реконструкции молочной железы на первом этапе комплексного лечения с использованием ПИ либо ТИ, были получены данные о том, что ПИ достоверно снижают риск возникновения капсулярной контрактуры почти в 1,5 раза [8].…”

Non -flapped brest reconstructions options using silicone endoprothesis after subcutaneous mastectomy for cancer

“…терапии. Те же авторы сообщают о риске возникновения капсульной контрактуры III и IV степени в 46 % случаев при использовании текстурированных имплантатов при реконструктивных операциях с последующей лучевой терапией.В работе A. Loreti с соавт [43]. также представ-…”