title: Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience.
abstract: BACKGROUND
  Capsular contracture (CC) is a major complication of breast surgery with smooth and textured implants. Polyurethane (PU) foam-coated breast implants were developed to decrease the incidence of CC.
  
  
  OBJECTIVE
  The authors determined the incidence of CC following 2-stage breast reconstruction using PU foam-covered implants, with and without radiation therapy.
  
  
  METHODS
  The records of 92 patients who received 115 PU implants were retrospectively reviewed. The rates of CC over time were compared for irradiated and nonirradiated groups with a Kaplan-Meier analysis and log-rank test. CC rates also were analyzed with respect to age.
  
  
  RESULTS
  The median follow-up time for patients was 103.3 months. Nine patients experienced unilateral Baker grade III or IV fibrous CC, including 6 patients from the irradiated group and 3 patients from the nonirradiated group. The overall cumulative incidence of CC at 9 years was 8.1%. In the irradiated and nonirradiated groups, the 9-year cumulative incidence was 10.7% and 5.5%, respectively. CC occurred within 3 years in the irradiated group and within 7 years in the nonirradiated group. The incidence of CC appeared to be higher among younger patients.
  
  
  CONCLUSIONS
  Radiation therapy increases the risk of high-grade CC with textured or smooth implants. PU implants are associated with a much lower cumulative incidence of CC following 2-stage breast reconstruction, even when radiotherapy is performed. LEVEL OF EVIDENCE 3.
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy. stefano.pompei1@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pompei
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Arelli
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Labardi
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marcasciano
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy.
authors.forename: Dora
authors.initials: D
authors.lastname: Evangelidou
authors.affiliation: Dr Pompei is Head of the Plastic and Reconstructive Surgery Unit, and Drs Arelli, Labardi, and Marcasciano are Consultant Plastic Surgeons, San Camillo Hospital, Rome, Italy. Dr Evangelidou is a Plastic Surgeon, Emirates Hospital Group Plastic and Reconstructive Surgery Department, Dubai, United Arab Emirates. Dr Ferrante is a Researcher, National Institute of Health, Rome, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ferrante
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation*; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D020099:Coated Materials, Biocompatible / Q000009:adverse effects; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008408:Mastectomy; D008875:Middle Aged; D011091:Polyesters / Q000009:adverse effects; D011140:Polyurethanes / Q000009:adverse effects; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D013499:Surface Properties; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D011091:Polyesters; D011140:Polyurethanes; C081821:microthane foam