ArticleAesthetic plastic surgery2026
Immediate Implant-Based Breast Reconstruction: Analysis of 787 Cases and Definition of Our Decision-Making Algorithm.
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundImmediate implant-based breast reconstruction (IBBR) following nipple-sparing (NSM) or skin-sparing mastectomy (SSM) increasingly requires individualized technique selection. Choosing among prepectoral direct-to-implant (DTI), submuscular DTI, and two-stage expander reconstruction remains complex. This study analyses outcomes from a large single-centre cohort to define a pragmatic, evidence-based decision-making algorithm.
methodsA retrospective monocentric review included all consecutive IBBR procedures performed between 2018 and 2024. Patients were allocated to three groups: prepectoral DTI (n = 601), submuscular DTI (n = 142), and two-stage expander reconstruction (n = 44). Demographic, oncologic, and surgical variables were collected. Major complications were evaluated using unadjusted analyses and inverse-probability-of-treatment weighting. A dedicated subgroup analysis was performed for patients receiving postmastectomy radiotherapy (PMRT).
resultsA total of 1,093 breasts were reconstructed. Weighted analysis showed similar overall major-complication rates for prepectoral and submuscular DTI (7.3% vs 8.4%, p = 0.278), while expanders demonstrated the lowest adjusted risk (0.7%). Within the PMRT subgroup, prepectoral DTI did not show increased infection, dehiscence, or seroma compared with the other techniques; infection was significantly lower than in submuscular DTI (2.7% vs 14.3%, p = 0.020). Capsular contracture was markedly less frequent in prepectoral DTI and remained significantly reduced after multivariable adjustment (OR 1 [reference]; OR 9.03 for submuscular DTI; OR 3.25 for expanders).
conclusionsOur resulting algorithm offers a structured, patient-specific approach to optimise outcomes in immediate implant-based breast reconstruction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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