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Optimal implant positioning following skin- (SSM) or nipple-sparing mastectomy (NSM) for breast cancer treatment or prevention is unclear. The PREPEC trial hypothesized pre-pectoral IBBR would result in improved long-term quality of life (QoL) compared to sub-pectoral IBBR.

OPBC-02/PREPEC (NCT04293146) was a pragmatic, international, randomized, phase-III superiority trial. Women undergoing SSM or NSM for breast cancer treatment or prevention were randomized (1:1) to pre-pectoral or sub-pectoral IBBR. The primary endpoint was patient-reported physical well-being chest (BREAST-Q) 24 months after surgery (prespecified MID 4 points). Multiple imputation addressed missing scores. The IBBR assignment difference was estimated by adjusted linear mixed modeling.

From July 2020 to February 2023, 383 patients were randomized at 26 OPBC centers in 10 countries. The full analysis set comprised 380 patients (191 randomized to pre-pectoral, 189 to sub-pectoral IBBR).
The results will be presented at the ESPRAS meeting in case of acceptance for oral presentation but cannot be displayed yet. The abstract is currently under review for oral presentation at ASCO. ASCO's embargo policy mandates that all submitted meeting abstracts and associated data are confidential until officially released by ASCO. Violating this policy may result in the abstract's withdrawal.

As soon as the embargo lifts, the results and conclusions will be submitted to ESPRAS.

Patients with breast cancer undergoing mastectomy with implant-based breast reconstruction (IBBR), who are at high risk of locoregional recurrence, often require postmastectomy radiotherapy (PMRT), which increases the risk of capsular contracture (CC). The present study assessed the association between use of polyurethane coated (PUc) versus non-PUc implants and the need for surgical revision due to CC in the setting of PMRT.

This international multicenter retrospective real-world study included patients with breast cancer who underwent nipple- (NSM) or skin-sparing mastectomy (SSM) with prepectoral IBBR with PUc vs. non-PUc implants followed by PMRT. Primary endpoint was surgical revision due to CC and was analyzed using Cox regression models.

1455 women treated between 2016 to 2022 at 26 sites in 15 countries (5 continents) were included. IBBR with PUc vs. non-PUc implants was performed in 475 (32.6%) and 980 (67.3%) of patients respectively. Median patient age was 47 years (IQR 40-54). Median follow-up was 2.5 years (IQR 1.3-3.5).
Of 1455 patients, 1109 (76.2%) had invasive ductal carcinoma and 785 (54.0%) hormone receptor–positive/HER2 negative disease, with a median Ki-67 of 25% (IQR 12-42%). Compared to non-PUc IBBR, use of PUc implants was associated with less frequent use of synthetic mesh or acellular dermal matrix (1.7% vs. 42.8%, p<=0.001) and with one-stage IBBR (91.6% vs. 78.1%, p<=0.001).
Compared to non-PUc, use of PUc implants was significantly associated with lower rate of surgical revision due to CC (9.3% vs. 25.7%; adjusted Hazard Ratio (aHR) 0.2, 95%CI 0.1-0.5, p<=0.001) and rate of any CC (32.8% vs. 47.5%; aHR 0.4, 95%CI 0.2-0.6, p<=0.001).
The likelihood of major infection (adjusted Odds Ratio (aOR) 0.3, 95%CI 0.2-0.6, p<=0.001), reoperation (aOR 0.3, 95%CI 0.2-0.6, p=0.001), implant loss (aOR 0.2, 95%CI 0.09-0.4, p<=0.001) and rotation (aOR 0.05, 95%CI 0.0-0.7, p=0.02) was also lower after IBBR with PUc implants.

This study showed a strong association between use of PUc vs. non-PUc implants and lower likelihood of surgical revision due to CC, as well as lower risk of surgical complications, in the setting of PMRT. These findings may inform implant selection and reconstructive planning for irradiated patients.

Reconstructive surgery is an integral component of standard treatment for breast cancer (BC). Given the existing diversity, physicians must select specific implant characteristics and placement options. The use of nano-textured implants in reconstructive surgery is of great interest [1]. Objective: to evaluate the efficacy and long-term outcome of nanotextured implants in breast cancer reconstructive surgery.

The study included 225 patients diagnosed with breast cancer between 2019 and 2024. Reconstructive plastic surgery was performed at the N.N. Alexandrov Russian Scientific and Practical Center of Oncology and Medical Radiology using exclusively nanotextured implants, installed using a special technique. This technique involves precisely selecting a group of patients with a body mass index no higher than average, calculating the thickness of the integumentary tissue, and performing full submuscular coverage of the implant using a combined pocket.

Patients included in the analysis had a body mass index (BMI) ranging from 18.5 to 29.0. Complications were noted in 13.3% of patients, including: prolonged seroma (more than 12-14 days) - 4.4%; postoperative hematoma — 2.2%; endoprosthesis protrusion — 2.2%; capsular contracture grades III–IV according to Baker — 2.2%; malposition — 1.3%; ripling — 0.9%. Quality of life assessment for social, physical, and psychological adaptation was characterized by high scores. Analysis of aesthetic results demonstrated a high satisfaction rate (excellent – ​​32.5%, satisfactory – 63.9%, unsatisfactory – 3.6%).

Breast reconstruction with nanotextured implants in women with a BMI from 18.5 to 29.0 is optimal. A low complication rate, satisfactory quality of life indicators, and a high aesthetic result were identified. The success of the reconstruction was determined by the clear formation of a patient profile for this type of surgery, as well as strict adherence to the correct placement technique [2].

Hybrid breast reconstruction, combining expander-to-implant reconstruction with serial autologous fat grafting (AFG; lipofilling), has emerged as a promising implant-based approach. The concept of reverse expansion aims to increase mastectomy flap thickness, thereby potentially improving implant coverage and ultimately aesthetic outcomes by progressively replacing the expander volume with non-vascularized autologous tissue. The aim of this study was to evaluate both short- and long-term patient-reported outcomes (PROMs) following reconstruction.

A retrospective single-center analysis was conducted including 25 patients who underwent nipple-sparing, skin-sparing, or skin-reducing mastectomy followed by bilateral multi-stage hybrid breast reconstruction. Patients completed the BREAST-Q questionnaire at two time points: early follow-up (3 months after final surgery) and long-term follow-up (≥24 months). Outcomes included satisfaction with physical, psychological and sexual well-being, as well as aesthetic outcome, donor-site morbidity and treatment burden. In addition, reconstructive and follow-up data were analyzed to explore the relationship between mastectomy weight and implant volume and to assess the need for secondary surgical procedures due to implant/reconstruction-related complications, or patient dissatisfaction.

Favorable PROMs were observed at short-term follow-up (3 months; n=23), including high scores for physical well-being (79.2), psychological well-being (70.8) and satisfaction with the reconstructed breasts (66.4), as well as low levels of perceived breast animation deformity (79.1) and rippling (3.5; scale range: 1–4, best). These outcomes further improved at long-term follow-up (mean 33 months, range: 24-50; n= 14) with a mean increase of 6.9%. Notably, donor site morbidity after lipofilling was moderate, with postoperative pain and dysesthesia being the most frequently reported symptoms, while the treatment burden of the multi-stage approach was generally well-tolerated.

Multi-stage hybrid breast reconstruction offers a promising and durable alternative to more traditional types of implant-based reconstruction by enhancing mastectomy flap thickness and reducing complications such as breast animation deformity and rippling, thereby improving short and long-term patient satisfaction.

Implant-based breast reconstruction is the most frequently performed reconstructive procedure following oncologic or prophylactic mastectomy worldwide. The current standard of care for periprosthetic infection consists of implant removal, followed by delayed secondary reconstruction after complete resolution of the infection, typically after approximately three months. This approach is associated with loss of the implant pocket and contraction of the skin envelope, resulting in functional, aesthetic, and psychosocial disadvantages. In recent years, negative pressure wound therapy (NPWT), particularly when combined with saline instillation and dwell time (NPWTi-d), has emerged as a potential salvage strategy for preservation of the implant pocket. The aim of this case series was to evaluate the effectiveness of NPWT/NPWTi-d for implant pocket salvage in the setting of periprosthetic infection following implant-based breast reconstruction.

A retrospective analysis was performed, including eight patients treated for periprosthetic infection after mastectomy between July 2021 and November 2025. All patients underwent a standardized salvage protocol consisting of implant removal, radical surgical debridement with (selective) capsulectomy, microbiological sampling, and application of NPWT or NPWTi-d. In five cases, an implant sizer was placed to preserve implant pocket volume. All patients received guideline-concordant, pathogen-directed antibiotic therapy.

Successful preservation of the implant pocket with sustained infection-free follow-up was achieved in 7 of 8 cases (87.5%). No therapy-related complications were observed. In cases treated with NPWTi-d since April 2025, a reduction in treatment duration to five days was observed using an otherwise unchanged protocol.

NPWT, and particularly NPWTi-d represents in light of the observed reduction in treatment duration, an effective and safe strategy for the preservation of infected implant pockets. Maintenance of implant pocket volume may facilitate early reimplantation and reduce the morbidity associated with autologous breast reconstruction or delayed breast reconstruction.

Periprosthetic infection after implant-based breast surgery remains a challenging complication and may result in implant loss and delayed reconstruction. Various salvage strategies have been described, with inconsistent outcomes. Loss of pocket integrity may compromise reconstructive outcomes and necessitate more complex secondary procedures. This study presents a pragmatic surgical concept for pocket preservation using temporary placement of a sterile implant sizer combined with negative pressure wound therapy.

A retrospective analysis was performed including patients requiring operative management of clinically diagnosed implant-associated breast infection. All included cases were treated using a pocket-salvage protocol: implant removal, pocket debridement and irrigation, temporary insertion of a sterile implant sizer wrapped in a vacuum-assisted closure sponge, and application of controlled negative pressure wound therapy. All patients received antibiotic therapy guided by microbiological culture and sensitivity testing (antibiogram). Definitive implant reimplantation was performed once local signs of infection had resolved and the patient’s clinical condition was stable.

All included patients underwent surgical pocket salvage using the described protocol. Successful preservation of the implant pocket was achieved in all cases, allowing for subsequent definitive implant reimplantation. The temporary sizer maintained pocket dimensions and soft-tissue architecture during infection control, while negative pressure wound therapy facilitated local wound conditioning and infection resolution.

Temporary placement of a sterile implant sizer combined with negative pressure wound therapy represents a clinically feasible and reproducible strategy for pocket salvage in implant-associated breast infection. This pragmatic approach maintains reconstructive integrity while enabling effective infection control and may reduce the need for complex secondary reconstruction.