Analysis: Negative Pressure Wound Therapy Linked to Fewer Complications After Prepectoral Breast Reconstruction
Key Takeaways
- Closed incision negative pressure wound therapy (ciNPWT) was associated with lower rates of several major 30-day complications after immediate prepectoral breast reconstruction with polyurethane-coated implants.
- In the retrospective study of 620 patients, wound dehiscence occurred in 1.17% of patients receiving ciNPWT versus 6.61% with conventional dressings; flap ischemia occurred in 0% versus 2.2%, respectively.
- The reported benefit was most evident among higher-risk patients, including those with thinner mastectomy flaps and mastectomy specimen weights of at least 500 g.
Closed incision negative pressure wound therapy (ciNPWT) was associated with fewer early postoperative complications following immediate prepectoral breast reconstruction with polyurethane-coated implants, according to a retrospective study published in Aesthetic Surgery Journal.
The authors evaluated 620 patients who underwent unilateral or bilateral conservative mastectomy followed by immediate prepectoral reconstruction with polyurethane-coated implants between May 2021 and February 2024. Of these, 257 received ciNPWT and 363 received conventional postoperative dressings.
ciNPWT Shows Greatest Benefit in Higher-Risk Breast Reconstruction
According to the results, wound dehiscence was reported in 1.17% of patients receiving ciNPWT versus 6.61% of controls. Flap ischemia occurred in 0% versus 2.2%, major infection in 0.39% versus 2.48%, and implant extrusion in 0.39% versus 2.2%, respectively. Minor complications were also less frequent with ciNPWT, including periprosthetic seromas ( overall minor complication rates of 4.28% versus 5.79%).
Investigators stratified patients by mastectomy flap thickness (0.5 to 0.6 cm, 0.7 to 0.9 cm, and at least 1.0 cm) and specimen weight below 500 g vs at least 500 g. The protective association with ciNPWT was most evident among patients with thinner flaps measuring 0.5 to 0.9 cm and those with specimen weights of at least 500 g. Correlation between intraoperative flap thickness and preoperative Rancati score also supported an association in higher-risk patients classified as Rancati type 1.
The retrospective design limited causal conclusions.
“ciNPWT reduces early complications in immediate prepectoral reconstruction, with greatest benefit in high-risk patients,” the authors concluded. “Integration into reconstructive protocols may enhance safety and broaden indications.”
Source
Salgarello A, et al. Aesthetic Surgery Journal. 2026. Doi:10.1093/asj/sjaf211