Immediate Breast Reconstruction with Prepectoral Polyurethane-Covered Implant After Conservative Mastectomy in Large and Ptotic Breasts

Introduction: Immediate breast reconstruction in patients with large and ptotic breasts represents a significant challenge due to the presence of skin redundancy and potential uncertain vascularization. This study investigates an innovative approach of performing immediate reconstruction using prepectoral polyurethane-covered (PU) implants after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with the aim of avoiding potential complications related to skin-reducing approaches and enhancing cosmetic outcomes. Materials and Methods: This retrospective study analyzed 62 patients who underwent NSM or SSM followed by immediate prepectoral reconstruction with polyurethane-covered implants between December 2018 and May 2024. The mastectomy weight ranged from 400 to 799g, while the volume of the implants varied from 335 to 680cc. All patients undergoing NSM used the lateral radial approach, patients undergoing SSM used the central elliptical lozenge including only the nipple–areola complex (NAC). The vitality of mastectomy flaps was assessed through intraoperative ICG angiography. Immediate and late complications, as well as aesthetic and functional outcomes, were evaluated. Data were collected and analyzed to determine the efficacy and safety of this reconstructive approach. Results: The analysis revealed a low incidence of early complications (11%), including wound dehiscence (6%), seromas (3%), and infection (2%), all managed conservatively. Late complications occurred in 29 patients (47%), with rippling (19%) and minor contour deformities (18%) affecting 37%. Autologous fat grafting was performed in 29% of cases for correction. Breast heaviness was reported in 8%, and capsular contracture (Grade III–IV) in 2%. No implant malposition or rotation was observed. Aesthetic outcomes (Likert scores: 1.8–1.9) and patient satisfaction (Breast-Q) were high, reflecting good reconstructive and functional results. Conclusions: The study demonstrates that the approach combining NSM or SSM with prepectoral reconstruction using PU implants is a valid alternative to skin-reducing mastectomy (SRM) for large and ptotic breasts. This method offers satisfactory aesthetic and functional results with minimal complication rate, representing a significant advancement in breast reconstruction techniques. Level of Evidence III: 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.