Comparison of revision surgery after implant-based breast reconstruction between smooth, textured, and polyurethane-covered implants: results from the Dutch Breast Implant Registry.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2025-04-30 DOI:10.1093/bjs/znaf082

J Xavier Harmeling,J Juliët Vrolijk,Erik Heeg,Babette E Becherer,Hinne A Rakhorst,Eveline M L Corten,Marta Fiocco,Marc A M Mureau

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Abstract

BACKGROUND Implant-based breast reconstruction is the most common technique after mastectomy. Breast implants are categorized by surface type as smooth, textured, or polyurethane-covered, each with specific attributed advantages and complication profiles. High-quality comparative studies are, however, limited. This study compared revision incidence and indications for revision among these implant types. METHODS A prospective, nationwide cohort from the Dutch Breast Implant Registry was analysed. Permanent implants used between 2017 and 2022 for direct-to-implant or two-stage reconstruction were included. Surface-related revision was the primary outcome. Cumulative incidences were estimated using a competing risk model. Cause-specific hazard ratios (HRcs) were calculated using univariable and multivariable models, accounting for implant clustering and confounders. Subgroup analyses examined revisions for specific complications. RESULTS Of 3996 implants, 76.9% were textured, 12.4% smooth, and 10.8% polyurethane-covered. At 4 years, the cumulative incidence of revision surgeries did not differ between textured (11.1%; 95% c.i. = 9.9 to 12.5), smooth (13.0%; 95% c.i. = 8.5 to 18.4), and polyurethane-covered (16.1%; 95% c.i. = 12.4 to 20.2) implants. Multivariable analysis found no association between surface type and surface-related revision. Subgroup analysis however revealed that polyurethane-covered implants had increased hazards of revision for capsular contracture (HRcs = 2.49; 95% c.i. = 1.24 to 5.01) and asymmetry (HRcs = 2.31; 95% c.i. = 1.33 to 4.02). CONCLUSION After adjusting for confounders and clustering, surface-related revision in a reconstructive setting did not significantly different among breast implant surface types overall. Polyurethane-covered implants may, however, require more revisions due to capsular contracture and asymmetry.

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光滑的、有纹理的和聚氨酯覆盖的假体乳房重建后修复手术的比较：来自荷兰乳房假体注册中心的结果。

背景：植体乳房重建是乳房切除术后最常见的技术。乳房植入物按表面类型分为光滑，有纹理或聚氨酯覆盖，每种都具有特定的优点和并发症概况。然而，高质量的比较研究是有限的。本研究比较了这些种植体类型的翻修发生率和翻修适应症。方法对来自荷兰乳房植入物注册中心的前瞻性全国队列进行分析。包括2017年至2022年间用于直接种植体或两阶段重建的永久种植体。表面相关修复是主要结果。使用竞争风险模型估计累积发生率。使用单变量和多变量模型计算原因特异性风险比（HRcs），考虑植入物聚类和混杂因素。亚组分析检查了针对特定并发症的修订。结果3996个种植体中，76.9%有纹理，12.4%光滑，10.8%聚氨酯覆盖。在4年的时间里，修复手术的累积发生率在纹理(11.1%；95% ci = 9.9 ~ 12.5)，平滑(13.0%；95% c.i. = 8.5至18.4)，聚氨酯覆盖(16.1%；95% c.i. = 12.4 ~ 20.2)种植体。多变量分析发现表面类型和表面相关修正之间没有关联。然而，亚组分析显示聚氨酯覆盖种植体增加了包膜挛缩翻修的危险(HRcs = 2.49；95% ci = 1.24 ~ 5.01)和不对称(HRcs = 2.31；95% ci = 1.33 ~ 4.02)。结论：在调整混杂因素和聚类因素后，乳房植入物表面类型在重建环境中的表面相关翻修总体上没有显著差异。然而，由于包膜挛缩和不对称，聚氨酯覆盖的植入物可能需要更多的修正。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.