Immediate Breast Reconstruction Using Smooth Round Implants: Long-Term Results

Introduction. Immediate breast reconstruction using smooth round implants has regained popularity following the abandonment of textured models due to their association with BIA-ALCL. However, the long-term results of DTI reconstruction with smooth implants remain poorly studied. The present study aims to evaluate the safety and efficiency of this method. Materials and methods. The retrospective study includes 48 patients (64 breasts) who underwent subcutaneous mastectomy with immediate reconstruction using smooth implants without additional covering materials. The observation period averages 54.5 months. The incidence of complications, oncological and surgical data, as well as risk factors for removal or replacement of implants are analyzed. Results. Early complications account for 10.94% with most common partial areola necrosis; late complications account for 20.31% mainly as type III–IV capsular contracture according to Baker. In 75% of cases, the implant was retained. High BMI, large implant volume and weight of removed tissue are significant factors in the development of complications. Discussion. The obtained data demonstrate comparable or better results compared to foreign studies. The absence of covering materials and subpectoral placement caused no negative effect on the incidence of infections; however, they correlate with animation deformity. The presence of postoperative radiation therapy significantly increases the risk of contracture. Conclusion. Immediate breast reconstruction using smooth implants demonstrates satisfactory long-term results with a low complication rate. The method can be considered as a safe alternative in conditions of limited access to ADM.

1. Kaoutzanis C., Winocour J., Kelamis J., Hirsch E.M., Layliev J., Halvorson E.G., et al. The evolution of breast implants. Semin Plast Surg. 2019;33(4):217–223. DOI: 10.1055/s-0039-1696985

2. Cronin T.D., Brauer R.O. Augmentation mammaplasty. Surg Clin North Am. 1971;51(2):441–52. DOI: 10.1016/s0039-6109(16)39388-4

3. Min K., Jeon D.N., Choi E.J., Lee T.J. Outcomes of saline implantbased immediate breast reconstruction: 15-year follow-up results. Arch Aesthetic Plast Surg. 2020;26(4):125–31. DOI: 10.14730/aaps.2020.02257

4. Nelson J.A., McCarthy C., Dabic S., Polanco T., Chilov M., Mehrara B.J., et al. BIA-ALCL and textured breast implants: a systematic review of evidence supporting surgical risk management strategies. Plast Reconstr Surg. 2021;147(5S):7S–13S. DOI: 10.1097/PRS.0000000000008040

5. Mousavi Z., Abolhasanpour N., Naseri A., Maghsoudi F., FarshbafKhalili A., Shahsavarinia K., et al. Cosmetic breast implants and the risk of suicide: a systematic review and meta-analysis. Iran J Psychiatry. 2023;18(3):319–31. DOI: 10.18502/ijps.v18i3.13008

6. Carr L.W., Roberts J., Potochny J.D. How breast implant surface type is influenced by breast implant-associated anaplastic large cell lymphoma: a survey of the American Society of Plastic Surgeons. Ann Plast Surg. 2019;82(4S Suppl 3):S208–11. DOI: 10.1097/SAP.0000000000001880

7. Solodkiy V.A., Sherstneva T.V., Meskih E.V., Izmailov T.R. The state of the issue of reconstructive plastic surgery for breast cancer in the Russian Federation and in the world. Bulletin of Pirogov National Medical & Surgical Center. 2018;13(3):132–7 (In Russ.). DOI: 10.25881/BPNMSC.2018.78.94.028

8. Shatova Yu.S., Przhedeckij Yu.V., Przhedetckaya V., Vashchenko L.N., Shevchenko N.A., Chernikova E.N. DTI prepectoral breast reconstruction with implants: texture vs polyurethane. Problems in Oncology. 2022;68(3):348–53 (In Russ.)ю DOI: 10.37469/0507-3758-2022-68-3-348-353

9. Bertulla E., Raposio E. Optimizing aesthetic results in implantbased breast reconstruction: patient factors, surgical techniques, and adjunctive strategies. J Clin Med. 2025;14(19):7106. DOI: 10.3390/jcm14197106

10. Seki H., Komiya T., Sowa Y., Kato M., Nishida Y., Isaka H., et al. Breast satisfaction and health-related quality of life following total mastectomy, breast-conserving surgery, or immediate breast reconstruction in Japanese patients with breast cancer: multicentre cross-sectional controlled study (Reborn). BJS Open. 2025;9(5):zraf094. DOI: 10.1093/bjsopen/zraf094

11. Denney B.D., Cohn A.B., Bosworth J.W., Kumbla P.A. Revision breast augmentation. Semin Plast Surg. 2021;35(2):98–109. DOI: 10.1055/s-0041-1727272

12. Paolini G., Firmani G., Briganti F., Macino M., Nigrelli S., Sorotos M., et al. Assessment of risk factors for rupture in breast reconstruction patients with macrotextured breast implants. Aesthetic Plast Surg. 2023;47(2):517–30. DOI: 10.1007/s00266-022-03118-9

13. Katsuragi R., Ozturk C.N., Chida K., Mann G.K., Roy A.M., Hakamada K., et al. Updates on breast reconstruction: surgical techniques, challenges, and future directions. World J Oncol. 2024;15(6):853–70. DOI: 10.14740/wjon1935

14. Haas E., Christodoulou N., Secanho M., Kokosis G., Malgor R.D., Winocour J., et al. Capsular contracture after breast augmentation: a systematic review and meta-analysis. Aesthet Surg J Open Forum. 2025;7:ojaf003. DOI: 10.1093/asjof/ojaf003

15. Sağir M., Güven E., Eröz S., Uras C. Implant selection in natural and stable direct-to-implant reconstruction with ten steps at nipple-sparing mastectomy. Medicine (Baltimore). 2023;102(19):e33758. DOI: 10.1097/MD.0000000000033758

16. Woo S.H., Yoon I.A., Choi E.J., Han H.H., Eom J.S., Lee T.J., et al. Outcomes of smooth round implant-based immediate breast reconstruction: Long-term follow-up results. J Plast Surg Hand Surg. 2023;57(1– 6):370–5. DOI: 10.1080/2000656X.2022.2118757

17. Fijany A.J., Chaker S.C., Hung Y.C., Zago I., Friedlich N., Olsson S.E., et al. Complication profiles of smooth vs textured tissue expanders in breast reconstruction: a systematic review and meta-analysis. Aesthet Surg J. 2024;44(4):383–93. DOI: 10.1093/asj/sjad319

18. Asaad M., Offodile A.C., Santanelli Di Pompeo F., Bevers T.B., Stelly S., Carew L.A., et al. Management of symptomatic patients with textured implants. Plast Reconstr Surg. 2021;147(5S):58S–68S. DOI: 10.1097/PRS.0000000000008047

19. Bushong E.E., Wesely N., Komorowska-Timek E. To acellular dermal matrix or not to acellular dermal matrix? Outcomes of pre-pectoral prosthetic reconstruction after nipple-sparing mastectomy with and without acellular dermal matrix. Gland Surg. 2024;13(6):885–96. DOI: 10.21037/gs-24-23

20. Zogheib S., Hanna C., Daou B., Mjaess G., Nasr M. Breast implant-associated double capsules: what do we know so far? A systematic review of the literature. Aesthetic Plast Surg. 2022;46(1):35–42. DOI: 10.1007/s00266-021-02443-9

21. Park B.C., Alving-Trinh A.L., Prigmore H.L., Harrell F.E. Jr, Sarhane K., Joseph J.T., et al. Impact of tissue expander surface texture on two-stage breast reconstruction outcomes: a combined analysis. Plast Reconstr Surg. 2024;153(6):1053e–62e. DOI: 10.1097/PRS.0000000000010763

22. Ma T., Li X., Sun X., Cao W., Niu Z., Wang H. Complications and patient-reported outcomes after radiotherapy in breast cancer patients undergoing implant-based breast reconstruction: a retrospective study from a large Chinese breast disease center. World J Surg Oncol. 2024;22(1):347. DOI: 10.1186/s12957-024-03618-9

23. Moon S., Min K., Kim T.H., Um J.H., Kook Y., Baek S.H., et al. Capsular contracture after postmastectomy radiation in implant-based breast reconstruction: effect of implant pocket and two-stage surgery. J Breast Cancer. 2024;27(6):395–406. DOI: 10.4048/jbc.2024.0141

24. King C.A., Bartholomew A.J., Sosin M., Avila A., Famiglietti A.L., Dekker P.K., et al. A critical appraisal of late complications of prepectoral versus subpectoral breast reconstruction following nipple-sparing mastectomy. Ann Surg Oncol. 2021;28(13):9150–8. DOI: 10.1245/s10434-021-10085-z

25. Stein M.J., Applebaum S.A., Harrast J.J., Lipa J.E., Matarasso A., Gosain A.K. Practice patterns in primary breast augmentation: a 16-year review of continuous certification tracer data from the American Board of plastic surgery. Plast Reconstr Surg. 2023;152(6):1011e–21e. DOI: 10.1097/PRS.0000000000010497

26. Min K., Min J.C., Han H.H., Kim E.K., Eom J.S. Comparing outcomes of prepectoral, partial muscle-splitting subpectoral, and dual-plane subpectoral direct-to-implant reconstruction: implant upward migration and the pectoralis muscle. Gland Surg. 2024;13(6):852–63. DOI: 10.21037/gs-24-45

27. Plotsker E.L., Stern C.S., Graziano F.D., Rubenstein R.N., Vingan P.S., Haglich K., et al. Surgical management of textured breast implants: assessing risk and analyzing patient-reported outcomes. Plast Reconstr Surg. 2024;154(1):39–52. DOI: 10.1097/PRS.0000000000010957

28. Christodoulou N., Secanho M., Kokosis G., Malgor R.D., Winocour J., Yu J.W., et al. Capsular contracture in breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2024;98:131–43. DOI: 10.1016/j.bjps.2024.08.057

29. Bryan J.L., Ockerman K.M., Spiguel L.R., Cox E.A., Han S.H., Trieu N., et al. Postoperative complications of direct-to-implant and twostaged breast reconstruction: a stratified analysis. Plast Surg (Oakv). 2024;33(4):574–81. DOI: 10.1177/22925503241276541

30. Bi S., Liu R., Wu B., Shen Y., Jia K., Sun K., et al. Breast implants for mammaplasty: an umbrella review of meta-analyses of multiple complications. Aesthetic Plast Surg. 2020;44(6):1988–96. DOI: 10.1007/s00266-020-01866-0

31. Vorstenbosch J., McCarthy C.M., Shamsunder M.G., Polanco T.O., Dabic S., Wiser I., et al. Smooth versus textured implant breast reconstruction: patient-reported outcomes and complications. Plast Reconstr Surg. 2021;148(5):959–67. DOI: 10.1097/PRS.0000000000008411

32. Han S.E., Lee K.T., Bang S. Comprehensive comparison between shaped versus round implants for breast reconstruction: a systematic review and meta-analysis. Aesthet Surg J. 2021;41(1):34–44. DOI: 10.1093/asj/sjaa128