Florian Fitzal, MD, MBA
Chief of Breast Reconstruction
Krankenhaus Hanusch, General Surgery and Breast Health Center Vienna
Wien, Wien, Austria
Rama Kiblawi, MD (she/her/hers)
Resident and Research Fellow
Breast clinic University Hospital Basel
Basel, Basel-Stadt, Switzerland
Kerstin Wimmer, MD
Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna
Wien, Wien, Austria
Florian Halbeisen, PhD
Surgical Outcome Research Center, University Hospital Basel and University of Basel
Basel, Basel-Stadt, Switzerland
Gianluca Franceschini, MD
Breast Unit, Department of Science and Health of Women, Children and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome,
Roma, Lazio, Italy
Lorenzo Scardina, MD (he/him/his)
Consultant Breast Surgeon
Breast Unit, Department of Science and Health of Women, Children and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
Roma, Lazio, Italy
Fabio Marazzi, MD
Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
Roma, Lazio, Italy
Dario Virzi, MD
Plastic Surgery Unit, Humanitas Istituto Clinico Catanese, Misterbianco, Catania
Catania, Sicilia, Italy
Konstantina Balafa, MD
Breast Surgery Unit, Humanitas Center, Catania
Catania, Sicilia, Italy
Maja Molska, MD
Clinical Department of General and Oncological Surgery, University Hospital in Zielona Góra, Zielona Góra
Zielona Góra, Lubuskie, Poland
Oliwia Bednarek, MD
Clinical Department of General and Oncological Surgery, University Hospital in Zielona Góra
Zielona Góra, Lubuskie, Poland
Martin Heidinger, MD (he/him/his)
Fellow
University Hospital Basel
Basel, Basel-Stadt, Switzerland
Edvin Ostapenko, MD, PhD
Edvin Ostapenko
Faculty of Medicine, Vilnius University
Vilnius, Vilniaus Apskritis, Lithuania
Khaled Mohamed Abdelwahab, MD
Mansoura Oncology Center, Surgical Oncology Department, Faculty of Medicine, Mansoura University, Mansoura
Mansoura, Ad Daqahliyah, Egypt
Amit Agrawal, MD (he/him/his)
Consultant Breast Surgeon, Associate Professor
Department of Breast Surgery, Cambridge University Hospitals, Cambridge
Cambridge, England, United Kingdom
Maggie Banys-Paluchowski, MD, PhD (she/her/hers)
Prof. Dr. med.
Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck
Lübeck, Schleswig-Holstein, Germany
Guldeniz Karadeniz Cakmak, MD
Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak
Zonguldak, Zonguldak, Turkey
Eduardo Gonzalez, MD
Department of Senology, Senology Unit, Sanatorio Modelo Quilmes, University of Buenos Aires
Buenos Aires, Buenos Aires, Argentina
Martin D. Haug, MD
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel
Basel, Basel-Stadt, Switzerland
Laura Henderson, MD
Department of Breast Surgery, Cambridge University Hospitals, Cambridge
Cambridge, England, United Kingdom
Elisabeth A. Kappos, MD
University of Basel and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel
Basel, Basel-Stadt, Switzerland
Michael Knauer, MD
Tumor and Breast Center Eastern Switzerland, St. Gallen
St. Gallen, Sankt Gallen, Switzerland
Jaime Letzkus B., MD
Breast Surgical Unit, San Borja Arriarán Clinical Hospital-Clínica MEDS, Santiago
Santiago, Region Metropolitana, Chile
Giacomo Montagna, MD, MPH
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Martín Rivas Ibarra, MD
Department of Breast Surgery, Arturo López Pérez Foundation
Santiago, Region Metropolitana, Chile
Simone Ross, PhD
Surgical Outcome Research Center, University Hospital Basel and University of Basel
Basel, Basel-Stadt, Switzerland
Dirk J. Schaefer, MD
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel
Basel, Basel-Stadt, Switzerland
Nicole Speck, MD
Dr.
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel
Basel, Basel-Stadt, Switzerland
Nikolas Tauber, MD
Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck
Lübeck, Schleswig-Holstein, Germany
José H. Volders, MD, PhD
Department of Surgical Oncology, Diakonessenhuis, Utrecht
Utrecht, Utrecht, Netherlands
Denise Vorburger, MD (she/her/hers)
Consultant Breast Surgeon
Breast Center, Department of Gynecology, Winterthur Cantonal Hospital
Winterthur, Zurich, Switzerland
Justin M. Broyles, MD
Division of Breast Surgery, Brigham and Women's Hospital, Dana Farber/Brigham Cancer Center, Boston
Boston, Massachusetts, United States
Lisa Stenman Skarsgård, MD
Department of Plastic and Reconstructive Surgery, Oslo University Hospital
Oslo, Oslo, Norway
Christian Korvald, MD, PhD
Department of Plastic and Reconstructive Surgery, Oslo University Hospital
Oslo, Oslo, Norway
Cynthia Kohl, MD
Interdisciplinary Breast Center, Kliniken Essen-Mitte, Essen
Essen, Nordrhein-Westfalen, Germany
Franziska Trapp, MD
Interdisciplinary Breast Center, Kliniken Essen-Mitte, Essen
Esse, Nordrhein-Westfalen, Germany
Simona Gipe, MD
Interdisciplinary Breast Center, Kliniken Essen-Mitte, Essen
Essen, Nordrhein-Westfalen, Germany
Daniele Passeri, MD
Veneto Institute of Oncology - IRCCS, Padova
Padova, Veneto, Italy
Mariacristina Toffanin, MD
Veneto Institute of Oncology - IRCCS, Padova
Padova, Veneto, Italy
Massimo Ferrucci, MD, PhD
Veneto Institute of Oncology
Veneto Institute of Oncology
Padova, Veneto, Italy
Walter P. Weber, MD (he/him/his)
Head of the Division of Breast Surgery
Breast Clinic, University Hospital Basel
Basel, Basel-Stadt, Switzerland
Patients with breast cancer undergoing mastectomy with implant-based breast reconstruction (IBBR), who are at high risk of locoregional recurrence, often require postmastectomy radiotherapy (PMRT), which increases the risk of capsular contracture (CC). The present study assessed the association between use of polyurethane coated (PUc) versus non-PUc implants and the need for surgical revision due to CC in the setting of PMRT.
Methods:
This international multicenter retrospective real-world study included patients with breast cancer who underwent nipple- (NSM) or skin-sparing mastectomy (SSM) with prepectoral IBBR with or without PUc implants followed by PMRT. Primary endpoint was surgical revision due to CC and was analyzed using Cox regression models.
Results:
1183 women treated between 2016 to 2022 at 19 sites in 13 countries (4 continents) were included. Of them, 773 (65.3%) underwent non-PUc IBBR and 410 (34.7%) PUc IBBR. Median age was 47 years (IQR 41-54) and median BMI was 24.4 kg/m2 (IQR 22-27.6). Median follow-up was 30.8 months (IQR 18.4-45.4) in the non-PUc group and 37.4 months (IQR 30-46.2) in the PUc group (p < 0.001).
Of 1183 patients, 863 (73%) had invasive ductal carcinoma and 654 (55.3%) hormone receptor–positive/HER2 negative disease, with a median Ki-67 of 25% (IQR 12-44%). Compared to PUc IBBR, use of non-PUc implants was associated with less frequent NSM (32.5% vs. 73.7%, p < 0.001), more frequent use of synthetic mesh (20.3% vs. 1%, p < 0.001) or acellular dermal matrix (20.3% vs. 1.2%, p < 0.001), and with one-stage IBBR (76.6% vs. 92.2%, p < 0.001).
Compared to PUc IBBR, use of non-PUc implants was associated with a higher rate of surgical revision due to CC (35.7% vs. 10.1%; hazard ratio [HR] 3.7, 95%CI 2.6-5.4, p < 0.001). The rate of any CC was also significantly higher in the non-PUc compared to the PUc group (58.7% vs. 33.3%; HR 1.9, 95%CI 1.5-2.4, p < 0.001).
The likelihood of major infection (OR 3.9, 95%CI 2.2-7.6, p < 0.001), implant loss (OR 11, 95%CI 6.7-19.1, p < 0.001), reoperation (OR 3.3, 95%CI 2.4-4.6, p < 0.001) and implant exposure (OR 7.9, 95%CI 2.6-35,p=0.001) was also higher in the non-PUc group.
Conclusions:
This study showed a strong association between use of non-PUc vs. PUc implants and higher likelihood of surgical revision due to CC, as well as higher risk of complications, in the setting of PMRT. These findings may inform implant selection and reconstructive planning for irradiated patients.