Neutrophil- and Platelet-to-Lymphocyte Ratios as Predictive Markers for Capsular Contracture after Immediate Implant-Based Reconstruction.

Abstract

Capsular contracture remains a significant complication of nipple-sparing mastectomy(NSM) with immediate direct-to-implant(DTI) reconstruction. Although local inflammation is known to contribute to its development, the role of systemic inflammatory markers remains unclear. This study aimed to evaluate whether preoperative systemic inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are associated with the increased risk of developing capsular contracture. The medical records of 376 patients who underwent NSM with DTI reconstruction were retrospectively reviewed. The patients were divided into the non-contracture group (grades 1 and 2) and the contracture group (grades 3 and 4) based on Baker's classification. Clinicopathological variables, including the preoperative NLR and PLR, were analyzed. Among the 376 patients, 43 (11.4%) developed grade 3 or 4 capsular contractures. The contracture group showed significantly higher proportions of patients who underwent radiotherapy or chemotherapy and those with elevated preoperative NLR and PLR levels. Multivariate analysis identified radiation therapy and elevated NLR and PLR as independent risk factors of capsular contracture. Subgroup analysis revealed that NLR and PLR were not predictive of contracture among patients who did not undergo radiotherapy, but remained significant predictors among those who did. Elevated preoperative NLR and PLR are associated with an increased risk of capsular contracture, particularly in patients receiving radiotherapy. These findings suggest that systemic inflammation, which is potentially exacerbated by radiation-induced fibrosis, may play a synergistic role in the development of capsular contracture. These markers may aid in preoperative risk stratification and support more personalized surgical planning.