Changing Paradigms in Polyurethane-coated Breast Implant Surgery: A Bibliometric Analysis of 4 Decades of Clinical Practice.

BACKGROUND: Polyurethane-coated breast implants were developed to reduce capsular contracture through enhanced implant-tissue interaction. After fluctuating clinical adoption driven by regulatory and safety concerns, renewed interest has emerged, particularly in immediate and prepectoral implant-based breast reconstruction. However, the structure and thematic evolution of the literature have not been systematically quantified. METHODS: A bibliometric analysis of the Web of Science Core Collection was performed, including articles and reviews published up to January 2026. Studies on polyurethane-coated breast implants in aesthetic or reconstructive surgery were included. Bibliometric indicators were analyzed using VOSviewer and Bibliometrix to evaluate publication trends, citation patterns, and research networks. RESULTS: A total of 136 publications (1978-2026) were identified. Output remained limited until the mid-2000s, followed by rapid growth after 2017, with publication volume peaking in 2025. Italy, the United States, and Brazil accounted for more than 60% of publications, with research concentrated in a few centers and core journals. Keyword analyses showed a shift from capsular contracture and surface biology toward prepectoral and direct-to-implant reconstruction. Breast implant-associated anaplastic large cell lymphoma emerged as a key recent topic. CONCLUSIONS: The literature has undergone a marked thematic shift toward contemporary reconstructive strategies. Despite increasing output, evidence remains dominated by small retrospective studies with limited comparative data. Prospective multicenter studies are needed to clarify long-term safety, including breast implant-associated anaplastic large cell lymphoma risk, and to define durable clinical and patient-reported outcomes.