Abstract PS2-01-01: Preoperative Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Capsular Contracture after Nipple-Sparing Mastectomy with Implant-Based Breast Reconstruction

Abstract Background: Capsular contracture is a major complication following nipple-sparing mastectomy (NSM) with direct-to-implant (DTI) breast reconstruction. While inflammation is a known contributor to capsular contracture, the role of systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) remains unclear. This study aimed to evaluate their predictive value for capsular contracture. Methods: We retrospectively reviewed 376 patients who underwent NSM with immediate DTI reconstruction. Patients were grouped by Baker’s classification into the non-contracture (grades 1–2) and the contracture (grades 3–4) groups. Clinical and pathological factors including preoperative NLR and PLR were analyzed. The optimal cut-off values for NLR and PLR were determined using receiver operating characteristic (ROC) curve analysis. Results: Among the 376 patients, 43 (11.4%) developed grade 3 or 4 capsular contracture during follow-up. The contracture group showed significantly higher rates of radiotherapy, chemotherapy, and elevated NLR/PLR. Multivariate analysis identified radiotherapy (OR 12.142, p<0.001) and elevated NLR and PLR (OR 5.287, p=0.001) as independent risk factors of capsular contracture. In subgroup analysis, NLR and PLR were not significant predictors among patients who did not receive radiotherapy, but remained significant among those who received radiotherapy (OR 7.334, p=0.002). Conclusion: Elevated NLR and PLR are associated with an increased risk of capsular contracture in patients undergoing NSM with DTI reconstruction, particularly in patients receiving radiotherapy. These findings suggest that systemic inflammation and radiation-induced fibrosis may contribute synergistically to capsular contracture development. As these markers are routinely available, they may serve as useful tools for preoperative risk stratification and individualized patient counseling in reconstructive breast surgery. Key words: Breast cancer, Nipple sparing mastectomy, Direct-to-implant reconstruction, Capsular contracture, Systemic inflammation, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Radiation therapy Citation Format: J. Kang, S. Jung, Y. Yoon, J. Oh, H. Koh, H. Shin, E. Kim, K. Yoon. Preoperative Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Capsular Contracture after Nipple-Sparing Mastectomy with Implant-Based Breast Reconstruction [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-01-01.