Dual-Plane Retromuscular Placement of Polyurethane-Coated Breast Implants in Patients with Compromised Pectoral Musculature: Clinical Outcomes

Background Polyurethane foam-coated breast implants have been associated with reduced capsular contracture and improved positional stability due to their distinct tissue–implant interface. However, evidence on their use in dual-plane retromuscular pockets, particularly for complex primary and secondary breast procedures, remains limited. Methods This retrospective, single-center study aimed to evaluate the clinical outcomes and surgical rationale for the selective use of polyurethane-coated implants in a dual-plane retromuscular pocket in complex breast surgery. Indications included compromised pectoralis major muscle, prior breast surgery, or insufficient soft tissue coverage. Demographics, indications, implant characteristics, complications, and reoperation rates were analyzed descriptively. Results Among 1293 implant-based breast procedures performed during the study period, 68 patients (5.3%) met the inclusion criteria. Procedures included augmentation ( n = 17), augmentation–mastopexy ( n = 49), and reduction with implants ( n = 2). The mean patient age was 38.1 years, and the mean implant volume was 350 mL. The mean follow-up was 9 months (range, 1–60 months). Overall, 5 patients (7.4%) required reoperation: 3 (4.4%) for cosmetic reasons and 2 (2.9%) for complications (an infection and a waterfall deformity). No cases of clinically significant capsular contracture, implant rupture, or major malposition were observed during follow-up. Conclusions In carefully selected complex primary and secondary breast cases, the use of polyurethane-coated implants in a dual-plane retromuscular pocket was associated with acceptable short-term complication and reoperation rates. This approach may represent a valuable option for patients with compromised musculature or limited soft tissue coverage, warranting further investigation in larger, prospective studies with longer follow-up. Level of Evidence IV 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 .