BREAST RECONSTRUCTION WITH IMPLANTS: ADVANTAGES AND DISADVANTAGES OF IMPLANT AND PATCH TYPES

Breast reconstruction following mastectomy is predominantly performed using implant-based tech-niques due to advantages such as shorter operative times, absence of donor-site morbidity, and rapid patient recovery compared to autologous reconstruction. Over the past two decades, advances in im-plant surface technology and the introduction of soft tissue substitutes have significantly reshaped surgical approaches, leading to improved aesthetic outcomes and reduced complication rates. Initially, subpectoral implant placement dominated reconstructive practice, offering robust implant coverage but frequently resulting in functional limitations such as animation deformity, prolonged recovery, and capsular contracture. The integration of acellular dermal matrices (ADM) in reconstructive procedures revolutionized the field by enabling a transition from full subpectoral coverage to dual-plane tech-niques, where the pectoralis major muscle partially covers the implant superiorly while ADM reinforc-es the inferior pole. ADM usage improved implant positioning, minimized muscle dissection, and sig-nificantly reduced capsular contracture rates. Subsequently, continuous refinement of ADM materials and techniques further facilitated the shift toward prepectoral reconstruction, completely eliminating muscle manipulation. Prepectoral implant placement, supported entirely by ADM or synthetic meshes, has rapidly gained popularity due to minimized postoperative pain, elimination of animation deformi-ties, shorter recovery periods, and more natural aesthetic outcomes. In parallel, synthetic meshes have emerged as cost-effective alternatives to ADMs. Although synthetic meshes generally require careful patient selection due to concerns regarding biocompatibility, infection risk, and mesh integration, they offer structural support comparable to ADM at reduced costs. Moreover, modern polyurethane-coated implants combined with lightweight gel technology have further simplified direct-to-implant prepec-toral reconstruction, permitting successful implant placement without ADM or mesh support, with low associated complication rates.Additionally, nanosurface implants have demonstrated the capability to reduce capsular contracture rates to less than 1% in aesthetic cases. It is our early experience that these implants may offer similar protective effects in reconstructive scenarios, maintaining low capsular contracture rates even in irradiated patients. In conclusion, advancements in implant technology and soft tissue substitutes have been instrumental in shifting implant-based breast reconstruction from subpectoral to dual-plane and, ultimately, prepectoral techniques. These innovations have considerably enhanced surgical outcomes and patient satisfaction, marking a significant evolution in reconstructive breast surgery. In this chapter, we share our institutional experience with immediate breast recon-struction conducted between 2018 and 2025, presenting outcomes related to the evolution of implant technologies and the use of various soft tissue substitutes.