Can the Use of Closed Incision Negative Pressure Wound Therapy in Immediate Prepectoral Breast Reconstruction With Polyurethane-Coated Implants Reduce the Rate of Early Complications?: A Comparative Study

Background: Immediate prepectoral breast reconstruction with polyurethane-coated implants provides esthetic and functional benefits compared with subpectoral techniques, but early postoperative complications remain a concern. Closed incision negative pressure wound therapy (ciNPWT) has demonstrated benefits in other surgical fields, though evidence in breast reconstruction is limited. Objectives: To evaluate whether ciNPWT reduces early postoperative complications after immediate prepectoral reconstruction with polyurethane-coated implants, particularly in high-risk patients. Methods: We retrospectively analyzed 620 patients undergoing unilateral or bilateral conservative mastectomy with immediate prepectoral reconstruction using polyurethane-coated implants between May 2021 and February 2024. Patients were divided into 2 cohorts: 257 treated with ciNPWT and 363 with conventional dressings. Subgroup analyses considered mastectomy flap thickness (0.5-0.6 cm, 0.7-0.9 cm, >= 1.0 cm) and specimen weight (<500 g vs >= 500 g). Early complications (<= 30 days) were classified as major (requiring reoperation or hospitalization) or minor. Results: ciNPWT significantly reduced major complications compared with controls: wound dehiscence (1.17% vs 6.61%), flap ischemia (0% vs 2.2%), major infection (0.39% vs 2.48%), and implant extrusion (0.39% vs 2.2%). Minor complications, including periprosthetic seromas, were also reduced (4.28% vs 5.79%). The protective effect was most evident in patients with thin mastectomy flaps (0.5-0.9 cm) and specimen weight >= 500 g. Correlation between intraoperative flap thickness and preoperative Rancati score confirmed benefits in high-risk patients (Rancati type 1). Conclusions: ciNPWT reduces early complications in immediate prepectoral reconstruction, with greatest benefit in high-risk patients. Integration into reconstructive protocols may enhance safety and broaden indications. Prospective randomized trials are warranted.