“Impact of Size of Acellular Dermal Matrix on Prevention of Capsular Contracture in Wrap-around Implant-based Breast Reconstruction”

BACKGROUND: Acellular dermal matrix (ADM) is widely used in implant-based breast reconstruction to enhance support and reduce capsular contracture (CC). Although manual meshing facilitates implant wrapping, excessive meshing enlarges the raw implant surface exposed to surrounding tissues. We hypothesized that the ADM-to-implant surface area ratio (AS ratio) correlates with CC risk. METHODS: This retrospective cohort study included patients who underwent immediate prepectoral implant-based breast reconstruction using the wrap-around technique between January 2020 and July 2023. Logistic regression with Generalized Estimating Equations (GEE) was performed to evaluate the association between the AS ratio and Baker grade III-IV CC incidence. RESULTS: A total of 730 breasts (541 non-irradiated, 189 irradiated) were evaluated. CC occurred in 7.4% of non-irradiated and 23.8% of irradiated breasts. In the multivariable analysis, a higher AS ratio was significantly associated with a lower risk of CC (OR, 0.781; p = 0.013). Radiotherapy remained the strongest risk factor, increasing CC odds 4.10-fold compared with the non-irradiated cohort (p<0.001). CONCLUSIONS: In this cohort of wrap-around implant-based breast reconstruction with smooth implants, a larger ADM surface area relative to implant surface area was associated with a lower risk of CC during the first two years after surgery. Prioritizing maximal ADM coverage and avoiding unnecessary meshing may help reduce CC risk.