Can the Use of Closed Incision Negative Pressure Wound Therapy in Immediate Prepectoral Breast Reconstruction With Polyurethane-Coated Implants Reduce the Rate of Early Complications?: A Comparative Study.

BACKGROUND

Immediate prepectoral breast reconstruction with polyurethane-coated implants provides esthetic and functional benefits compared with subpectoral techniques, but early postoperative complications remain a concern. Closed incision negative pressure wound therapy (ciNPWT) has demonstrated benefits in other surgical fields, though evidence in breast reconstruction is limited.

OBJECTIVES

To evaluate whether ciNPWT reduces early postoperative complications after immediate prepectoral reconstruction with polyurethane-coated implants, particularly in high-risk patients.

METHODS

We retrospectively analyzed 620 patients undergoing unilateral or bilateral conservative mastectomy with immediate prepectoral reconstruction using polyurethane-coated implants between May 2021 and February 2024. Patients were divided into 2 cohorts: 257 treated with ciNPWT and 363 with conventional dressings. Subgroup analyses considered mastectomy flap thickness (0.5-0.6 cm, 0.7-0.9 cm, ≥1.0 cm) and specimen weight (<500 g vs ≥500 g). Early complications (≤30 days) were classified as major (requiring reoperation or hospitalization) or minor.

RESULTS

ciNPWT significantly reduced major complications compared with controls: wound dehiscence (1.17% vs 6.61%), flap ischemia (0% vs 2.2%), major infection (0.39% vs 2.48%), and implant extrusion (0.39% vs 2.2%). Minor complications, including periprosthetic seromas, were also reduced (4.28% vs 5.79%). The protective effect was most evident in patients with thin mastectomy flaps (0.5-0.9 cm) and specimen weight ≥500 g. Correlation between intraoperative flap thickness and preoperative Rancati score confirmed benefits in high-risk patients (Rancati type 1).

CONCLUSIONS

ciNPWT reduces early complications in immediate prepectoral reconstruction, with greatest benefit in high-risk patients. Integration into reconstructive protocols may enhance safety and broaden indications. Prospective randomized trials are warranted.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.