The Impact of Breast Implant Cohesivity on Rippling and Revision Procedures in 2-Stage Prepectoral Breast Reconstruction

Abstract

Background Rippling remains one of the most common complications following prepectoral implant-based reconstruction (IBR). Objectives The purpose of this study was to assess how implant cohesivity, a measure of elasticity and form stability, effects the incidence of rippling in prepectoral IBR. Methods We performed a retrospective cohort study of two-stage prepectoral IBR performed between January 2020 and June 2022 at the Brigham and Women’s Hospital and Dana Farber Cancer Institute, comparing outcomes in patients who received Allergan Natrelle® least cohesive, moderately cohesive, and most cohesive silicone gel implants. Outcomes of interest were rippling and re-operation for fat grafting. Results 129 patients were identified, of whom 52 had the least cohesive implants, 24 had the moderately cohesive implants, and 53 patients had the most cohesive implants. Mean follow-up time was 463 (± 220) days. Decreased incidence of rippling was seen with moderately cohesive (OR 0.30, p < 0.05) and most cohesive (OR 0.39, p < 0.05) implants. Third stage re-operation for fat grafting was less frequent in patients with the most cohesive implant (OR 0.07, p < 0.05). In subgroup analyses, the patients with the most cohesive implant, who did not receive fat grafting at the time of initial implant placement, did not require re-operation for fat grafting (0%). Conclusions The use of highly cohesive implants in prepectoral IBR is associated with decreased rippling and fewer re-operations for fat grafting.