Background Round nano-surface Ergonomix implants were developed to address concerns regarding capsular contracture and textured anatomical breasts implants. Objectives We describe our early experience with Ergonomix implants in breast reconstruction. Methods We retrospectively reviewed the charts of 212 patients (321 breasts) that underwent breast reconstruction using round nano-surface Ergonomix implants at our institution between June 2017-December 2020. Patients were followed for at least 12-months postoperatively. Demographics, surgical data, and post-operative surgical outcomes were recorded. Postoperative physical well-being and satisfaction with the breasts and implant were evaluated using the Breast-Q questionnaires. Results Of 211 patients, 75.4% had surgery due to cancer, and 24.6% had prophylactic surgery. Major complications occurred in 21 breasts (6.5%) of which 20 had revision operations. Reconstruction failed in one case (0.3%). Eleven breasts (3.4%) had minor complications. Immediate breast reconstruction, irradiated breasts and smokers had higher rates of complications (p = 0.009, 0.02, 0.022, respectively). Rippling was more common in the pre-pectoral implant plane compared to sub-pectoral reconstruction (9% vs. 1.2%, p = 0.001). Capsular contracture rate was 0.9% and occurred only in irradiated-breasts. Implant malposition (inferiorly and laterally) occurred in 6.5% of the breasts, with no association between implant malposition and implant plane. Early follow-up demonstrated high patient satisfaction with the implant and the breasts, and high scores in terms of patients’ physical well-being. Conclusions Breast reconstruction using the round nano-surface Ergonomix implant yielded low complication rates and high patient satisfaction. The transition from macro-textured to nano-surface implants has operative implications requiring a learning curve and surgical adjustments.

Fat necrosis is a common complication of breast surgery, with the potential to cause both functional and aesthetic repercussions that can affect patient satisfaction. Although several fat necrosis classification systems have been proposed, fat necrosis management varies widely across institutions, requiring revisiting of existing treatment protocols. We evaluated the postoperative outcomes on 335 breasts following either breast reduction or reconstruction with deep inferior epigastric perforator (DIEP) flaps at our institution between 2016 and 2020, with particular attention to the development of fat necrosis and the need for subsequent surgical intervention. Fat necrosis was diagnosed in 36 (10.74%) breasts, of which 16 (44.4%) were surgically removed and 20 (55.5%) were conservatively managed. Time of fat necrosis diagnosis: early (≤one-month after breast surgery) or late (>1 month) was the only variable associated with surgical intervention. Fat necrosis management should be approached on a case-by-case basis. Whenever possible, conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications.