Back to 2025 Abstracts
Long-term Outcomes of Prepectoral Direct-to-Implant (DTI) Breast Reconstruction with the Poly-4-Hydroxybutyrate Wrap
Thomas J. Sorenson
*, Carter J. Boyd, Kshipra Hemal, Chris Amro, Jenn Park, Nicholas Vernice, Alexis Lakatta, Oriana Cohen, Mihye Choi, Nolan S. Karp
Hansjorg Wyss Department of Plastic Surgery, New York University-Grossman School of Medicine, New York, NY
Purpose: Prepectoral direct-to-implant (DTI) breast reconstruction has gained popularity for reducing postoperative pain, animation deformity, and surgeries. However, the limited vascularized tissue overlying the implant presents challenges in implant positioning, complication management, and aesthetic outcomes. This study evaluates long-term outcomes in prepectoral DTI patients using a novel poly-4-hydroxybutyrate (P4HB) wrap designed to minimize implant microshifting and optimize reconstructive results.
Methods: We retrospectively reviewed all consecutive patients who underwent prepectoral DTI breast reconstruction with our P4HB-implant construct. Data were collected via chart review.
Results: There were 50 patients with 87 breasts undergoing prepectoral DTI reconstruction. The mean (± SD) age of patients was 52.7 (± 11.7) years, and the median (IQR) BMI was 23 (5) kg/m2). No patients were current smokers; no patients had diabetes mellitus. The mean (± SD) follow-up time was 18.1 (± 5.1) months. Thirty (30/50; 60%) patients did not require further surgery beyond the index operation. Of the patients requiring a subsequent operation, the majority (12/20; 60%) were for aesthetic optimization due to rippling. Eight (8/87; 9.2%) breasts required a subsequent operation due to postoperative complications with four (4/87; 4.6%) of these breasts requiring removal of the construct. Increased BMI and age were found to significantly decrease the odds of rippling (ORs 0.73 and 0.89, respectively), and increased BMI was also found to significantly increase the odds of major complications (OR 1.21) in our patients.
Conclusions: This is the first study reporting long-term P4HB outcomes in prepectoral DTI breast reconstruction at full hydrolysis (18 months). Most patients did not require revisional surgery, and reoperations were primarily for aesthetic concerns. Postoperative complications leading to explantation were rare. These findings suggest P4HB is a safe, effective adjunct for implant stabilization and soft tissue support in prepectoral DTI breast reconstruction.
Back to 2025 Abstracts
