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Impact Of Implant Cohesivity On Capsular Contracture Incidence And Time-to-Event In Pre-Pectoral Breast Reconstruction
Yizhuo Shen, M.M.Sc.1, Renee Gao, BS
2, Goutam Gadiraju, BS
3, Hannah Shi, BA, BS
3, Alex Dong, BS
3, Yibin Zhang, BS
3, Justin Broyles, MD, MPH
4.
1Yale School of Medicine, New Haven, CT, USA,
2UMass Chan Medical School, Worcester, MA, USA,
3Harvard Medical School, Boston, MA, USA,
4Brigham and Women's Hospital, Boston, MA, USA.
PURPOSE: Capsular contracture is a leading complication after implant-based breast reconstruction (IBR), however, the direct cohesivity-contracture relationship remains untested. This is the first study to evaluate the effects of implant cohesivity on capsular contracture in IBR.
METHODS: A retrospective review of 289 patients undergoing 437 pre-pectoral direct-to-implant (DTI) breast reconstructions from 2020 to 2024 was performed. Implant cohesivity was standardized and separated by least, moderately, and most cohesive. Multivariable regression and Cox proportional hazards models were applied for analysis.
RESULTS: Over median follow-up of 470 days (IQR 290-811), 49 contracture events occurred. Its incidence was highest with least cohesive implants (20.7%) and decreased with increasing cohesivity (7.0% moderate, 8.0% most cohesive; p<0.05). Moderately (OR 0.28, 95% CI 0.12-0.66, p=0.004; HR 0.46, 95% CI 0.21-0.98, p=0.045) and most cohesive (OR 0.40, 95% CI 0.18-0.90, p=0.027; HR 0.51, 95% CI 0.27-0.96, p=0.038) implants demonstrated significantly reduced odds and hazard of contracture compared to least cohesive. Kaplan-Meier curves revealed that most contractures occurred before 1000 days and plateaued early for higher cohesivity implants. However, least cohesive implants exhibited both early contractures and late-onset events.
CONCLUSION: Higher cohesivity is independently associated with lower incidence and delayed onset of capsular contracture in pre-pectoral DTI reconstruction. Implant cohesivity is a modifiable factor in contracture prevention, underscoring the need for long-term data to inform implant selection, complication surveillance timeframe, and practice guidelines.
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