Retrospective cohort study demonstrates that higher acellular dermal matrix coverage reduces capsular contracture in breast reconstruction, suggesting the value of limiting manual meshing.
Key Points
To determine whether the ratio of acellular dermal matrix surface area to implant surface area is associated with the risk of severe capsular contracture in wrap-around prepectoral breast reconstruction.
Conducted a retrospective cohort study of patients undergoing immediate prepectoral implant-based breast reconstruction with smooth implants and the wrap-around technique between January 2020 and July 2023 (N=730 breasts).
Assessed the association between the acellular dermal matrix-to-implant surface area (AS) ratio and Baker grade III–IV capsular contracture using multivariable logistic regression with generalized estimating equations.
Capsular contracture occurred in 7.4% of non-irradiated breasts (40/541) and in 23.8% of irradiated breasts (45/189).
Higher AS ratio was independently associated with a reduced risk of capsular contracture (OR, 0.781; p = 0.013).
Radiotherapy served as the strongest independent risk factor, increasing the odds of capsular contracture 4.10-fold relative to non-irradiated breasts (p < 0.001).