Breast reconstruction using polyurethane-coated implants reduces scarring and need for further surgery: Study

Women who are treated with mastectomy for breast cancer often choose to have surgery to reconstruct the breast using an implant. But hard, painful scar tissue can form around the implant, especially when women have radiotherapy as part of their treatment.

New research, presented at the 15th European Breast Cancer Conference (EBCC15) in Barcelona today (Wednesday), shows that the risk of this scarring and the need for further corrective surgery could be reduced if women are given a polyurethane-coated breast implant. These implants are made of silicon, but they have a spongy outer layer, made of polyurethane.

The research was presented by Dr Kerstin Wimmer, a surgeon at the Medical University of Vienna, Austria, and a researcher at the Karolinska Institutet in Stockholm, Sweden, and carried out by a team including Professor Walter Weber, University Hospital Basel, Switzerland, Professor Florian Fitzal, Hanusch Hospital, Vienna, Austria, and Dr Rama Kiblawi, University Hospital Basel, Switzerland.

Dr Wimmer said: “It is well known that radiotherapy after mastectomy increases the risk of complications in women who have breast reconstruction with an implant. One of the most important complications is capsular contracture, where scar tissue forms around the implant, leading to a hard, uncomfortable and sometimes painful breast, but also to visible changes in breast shape.

“This situation is relatively common, as many women with high-risk breast cancer need radiotherapy after mastectomy. However, there is limited real-world evidence on whether the type of implant can influence the risk of scarring.”

The research included 1455 women treated for breast cancer between 2016 and 2024 at 26 sites in 15 countries [1]. The average age of the women was 47. All were treated with mastectomy (removal of the breast), followed by reconstruction with a breast implant, with 475 of the women receiving a polyurethane-coated implant and 980 receiving an implant without polyurethane coating. All the women then received radiotherapy.

Following treatment, researchers continued to track the women’s health for two-and-half to three years. They found that women who received a polyurethane-coated implant were less likely to develop any signs of capsular contracture (scar tissue) (32.8% compared to 47.5% of women who received a non-polyurethane-coated implant) and less likely need a second operation to remove scar tissue (9.3% compared to 25.7% of women who received a non-polyurethane-coated implant). The risks of a major infection in the breast or the implant having to be urgently removed were also lower.

The study was retrospective, meaning researchers looked back at how the two types of implants influenced the outcomes of surgery, so treatments were not randomly assigned.

Dr Wimmer told the conference: “Our study suggests that women who received polyurethane-coated implants had far fewer problems after radiotherapy than those who received standard implants. For patients, this research suggests that the type of implant used may have a major impact on the risk of complications after radiotherapy. For clinicians, it provides important evidence to help guide reconstructive planning for patients who are likely to need radiotherapy.

“The choice of implant can depend on several factors, including the surgeon’s experience and preference, availability of implants, cost, local regulations, and the individual patient’s situation. Polyurethane-coated implants have been used for many years and are generally considered safe. Like all medical devices, they can have complications, which is why careful follow-up and long-term monitoring are important.”

This research has been recognised with the EBCC15 Multidisciplinary Team Award and was carried out within the framework of the Oncoplastic Breast Consortium, an international research network that brings together breast surgeons and researchers from around the world.

The Chair of EBCC15, Professor Isabel Rubio, Head of Breast Surgical Oncology at the Clínica Universidad de Navarra in Madrid, Spain, was not involved in this research. She said: “This study highlights an important step forward in improving long-term outcomes for women undergoing breast reconstruction after mastectomy. While reconstructive surgery has advanced considerably, capsular contracture remains one of the most challenging complications, particularly for patients who also require radiotherapy. The findings suggest that polyurethane-coated implants may reduce the risk of capsular contracture and the need for additional corrective surgery. If confirmed in further prospective studies, this approach could help improve patient comfort, aesthetic outcomes and overall quality of life.

“As we continue to move towards more personalised breast cancer care, evidence like this is valuable in guiding implant selection and treatment planning. The ultimate goal is not only to treat the cancer effectively, but also to minimise long-term side effects and enhance recovery for patients.”

Reference:

Breast reconstruction using polyurethane-coated implants reduces scarring and the need for further surgery, European Organisation for Research and Treatment of Cancer, Meeting:15th European Breast Cancer Conference.