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.

Abstract

Background: Immediate prepectoral breast reconstruction with polyurethane-coated implants provides aesthetic 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 two 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.