Immediate implant breast reconstruction with total musculofascial coverage: Outcome of 1,180 consecutive...

Immediate implant-based breast reconstruction (IBR) is widely performed following mastectomy, yet the optimal implant placement technique remains debated. This retrospective analysis of a prospectively maintained cohort evaluates outcomes of direct-to-implant reconstruction using total musculofascial coverage (TMFC) in a large single-centre experience.

We analysed 1180 consecutive immediate implant reconstructions performed between 2005 and 2024 at the Paris Breast Centre. All reconstructions aimed for total musculofascial coverage without acellular dermal matrix, except when anatomically unfeasible. Primary endpoints included early postoperative complications and implant loss. Secondary endpoints assessed delays in adjuvant therapy and frequency of revision procedures.

A total of 924 patients (1180 breasts) underwent immediate reconstruction. Median follow-up was 38 months, with 37.1% of patients being followed more than 5 years. The overall early complication rate was 23.0%, with infection (5.6%) and seroma (5.5%) being the most common. Implant loss occurred in 2.1% of cases, and 7.3% required unplanned reoperation. Multivariate analysis identified increasing age, breast weight, and implant volume as independent predictors of complications. Adjuvant chemotherapy and radiotherapy were initiated within normal timeframes, with only minor delays observed in patients with complications. Second-stage aesthetic procedures were performed in 51.9% of patients, with fat grafting being the most common.

Total musculofascial implant coverage in IBR provides a safe and effective approach with low implant loss rates. Our series supports the use of TMFC in selected patients. Further randomized studies are warranted to compare long-term outcomes with alternative techniques such as prepectoral placement.