Inpatient breast implant surgery in Germany (2006-2023): A national analysis of technical shifts, safety-driven revision, and centralization.

Abstract

Breast implant surgery is currently defined by rapid technical innovation and heightened safety vigilance (e.g., Poly Implant Prothèse [PIP] and breast implant associated anaplastic large cell lymphoma [BIA-ALCL]). This study analyses the German national inpatient landscape-representing the country's reconstructive core and complex revision workload-to document eighteen-year systemic shifts in technique, safety management, and care delivery. A retrospective nationwide analysis of German inpatient records (2006-2023) was performed, identifying all breast implantations, exchanges, and explantations via procedure-specific and International Classification of Diseases, 10th edition, codes. Temporal trends in implant pocket plane, capsulectomy frequency, and regional concentration were evaluated using segmented negative binomial and fractional logit regression models. Primary implantations rose 181% between 2012 and 2023 (incidence rate ratio 2.36, p < 0.001), driven by a decisive migration from subpectoral to prepectoral placement (76.6% of primaries by 2023). Revision complexity increased parallel to volume: the share of capsulectomy-associated procedures rose from 58% in 2006 to 67% in 2023 (p < 0.001), consistent with an increasingly capsulectomy-associated revision pattern, without implying a specific causal driver. Geographically, complex revisions increasingly consolidated into metropolitan hubs, reinforcing a structural volume-outcome relationship. The German inpatient sector has transitioned towards a prepectoral reconstructive standard and centralised, vigilance-based revision care. While this hospital-based analysis largely excludes elective aesthetic cases, it provides the essential epidemiological baseline and reconstructive census required for the effective implementation of the new mandatory national breast implant registry.