Standalone Microthane® breast implants in the prepectoral position: Positive outcomes from combining technical and surgical advantages supported by patient-reported outcomes

Immediate breast reconstruction (IBR) with polyurethane (PU)-coated implants has usually been performed to mitigate the capsular contracture (CC) rate, particularly in patients requiring post-mastectomy radiotherapy (PMRT). This retrospective study aimed to evaluate the long-term outcomes of direct-to-implant (DTI) reconstruction using Microthane® PU-coated implants placed prepectorally without additional devices. A total of 143 consecutive patients underwent mastectomy, followed by IBR with Microthane® implants in the prepectoral position. Demographic and clinical data, including complications and CC incidence, were retrospectively collected. Statistical analyses comprised descriptive statistics, Kaplan-Meier survival curves, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for patient-reported outcomes. Over a median follow-up of 4.5 years, 18.9 % of patients experienced at least one complication, with adjuvant radiotherapy being the only factor significantly associated with increased complications (<i>p</i> = 0.0229). Kaplan-Meier analysis indicated a complication-free survival rate of 57.85 % for the patient and 58.00 % for the implant, and a contracture-free survival rate of 79.46 % and 81.56 %, respectively. Severe CC (Baker grade III/IV) occurred only in 9.1 % of patients, including several who underwent adjuvant radiotherapy (<i>p</i> = 0.0215). These rates remain notably lower than those historically reported with textured implants. Moreover, DASH scores revealed minimal disability (an overall mean score of 8.17 %), reflecting favorable patient-reported outcomes. Microthane® breast implants in a prepectoral position demonstrated low CC rates and high patient satisfaction, even among those receiving radiotherapy, benefiting from all the prepectoral surgical approaches. In addition, this technique obviates the need for supplementary devices such as meshes or acellular dermal matrices (ADMs), thereby reducing costs, operative times, and potential complications. The large cohort size and substantial follow-up strengthen these findings. The results support prepectoral reconstruction with Microthane® implants as a safe and effective option in breast reconstruction, offering both aesthetic and functional benefits.