Breast augmentation has evolved significantly since its inception in the 1960s, with polyurethane (PU)-coated breast implants emerging as a notable innovation in the 1970s. Despite their potential advantages in reducing capsular contracture, concerns persist among surgeons regarding their safety and technical challenges, particularly in primary augmentation mammoplasty. The aim of this study was to highlight the numerous advantages and safety of PU implants, promoting them as a viable option for primary augmentation mammoplasty. The authors experience documented in the form of a case series was combined with a systematic review that examined the safety and efficacy of PU-coated breast implants for primary augmentation mammoplasty. A case series involving 50 patients who underwent this procedure from January 2023 to January 2024 is reported. Additionally, a comprehensive literature review from 2000 to 2023, using the PubMed, CINAHL, EMBASE, and Scopus databases, along with clinical experience and case reports were conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies indicate a low risk of malignancy associated with PU-coated implants, with no evidence of free 2,4-toluenediamine in the serum samples. A nearly nonexistent occurrence of capsular contracture, along with minimal surgical complexities make it an excellent choice for achieving functional and aesthetic results. PU-coated breast implants demonstrate equivalence to standard textured implants for primary augmentation mammoplasty, with advantages including reduced capsular contracture rates and improved stability. Despite historical skepticism, evidence supports their safety and effectiveness, positioning them as a viable option in breast augmentation surgery. Implementation of appropriate surgical techniques is paramount to optimizing outcomes and ensuring patient satisfaction.

Pre-pectoral (PP) direct-to-implant (DTI) breast reconstruction has gained popularity as a muscle-sparing alternative to subpectoral techniques. Polyurethane-coated implants, with their unique mechanical and biological properties, may further optimize outcomes by reducing capsular contracture and improving implant stability. This systematic review aimed to evaluate the safety, efficacy, and patient-reported outcomes of post-mastectomy PP DTI breast reconstruction using polyurethane-coated implants. A systematic search of PubMed, Embase, Scopus, and Cochrane Library databases was conducted in accordance with PRISMA guidelines. Data on study design, patient and surgical characteristics, complications, aesthetic outcomes, and patient satisfaction were extracted. Risk of bias was assessed using the ROBINS-I tool. Thirteen studies met inclusion criteria, comprising 1717 patients and 2502 breasts reconstructed with polyurethane-coated implants. Mean follow-up across included studies was 12.3 months (range 1-60 months). Mean implant size was 327 cc (range 160-680 cc). Across all studies, implant loss occurred in 1.0% of cases and infection in 0.9%. Capsular contracture with reported Baker grade III-IV cases occurred in 1.0% of cases within ≤12 months of follow-up, increasing to 12.3% in studies with ≥36 months’ follow-up. The most frequent aesthetic drawback was rippling or contour deformity, affecting 183 breasts (7.3%). Patient-reported satisfaction was consistently favorable: 5 studies using the BREAST-Q reported mean scores ranging from 72.6 to 78.3 for Satisfaction with Breasts and 79.9 to 84.6 for Psychosocial Well-Being. Pre-pectoral DTI reconstruction with polyurethane-coated implants is a safe and effective technique, associated with low complication rates and high patient satisfaction. Careful flap selection and adjunctive fat grafting optimize results. Prospective multicenter studies with long-term follow-up are warranted to confirm durability and refine patient selection criteria. Level of Evidence: 3 (Therapeutic):

Background: Tuberous breast deformity (TBD) is a congenital condition characterized by constriction of the breast base, parenchymal hypoplasia, and areolar herniation. The absence of a universally accepted classification system complicates diagnosis and surgical planning, leading to variability in clinical outcomes. Artificial intelligence (AI) has emerged as a powerful adjunct in medical imaging, enabling objective, reproducible, and data-driven diagnostic assessments. Objectives: This study introduces an AI-driven diagnostic tool for TBD classification using a Siamese network trained on paired frontal and lateral images. Additionally, the model generates a continuous Tuberosity Score (ranging from 0 to 1) based on embedding vector distances, offering an objective measure to enhance surgical planning and improved clinical outcomes. Methods: A dataset of 200 expertly classified frontal and lateral breast images (100 tuberous, 100 non-tuberous) was used to train a Siamese network with contrastive loss. The model extracted high-dimensional feature embeddings to differentiate tuberous from non-tuberous breasts. Five-fold cross-validation ensured robust performance evaluation. Performance metrics included accuracy, precision, recall, and F1-score. Visualization techniques, such as t-distributed Stochastic Neighbor Embedding clustering and occlusion sensitivity mapping, were employed to interpret model decisions. Results: The model achieved an average accuracy of 96.2% ± 5.5%, with balanced precision and recall. The Tuberosity Score, derived from the Euclidean distance between embeddings, provided a continuous measure of deformity severity, correlating well with clinical assessments. Conclusions: This AI-based framework offers an objective, high-accuracy classification system for TBD. The Tuberosity Score enhances diagnostic precision, potentially aiding in surgical planning and improving patient outcomes.