Capsule Preservation Breast Reconstruction Following Nipple-Sparing Mastectomy in Patients With Prior Breast Augmentation.

[BACKGROUND] Patients with prior breast augmentation provide an opportunity for capsule preservation and possible direct-to-implant breast reconstruction immediately following nipple-sparing mastectomy (NSM). However, clinical outcomes and postoperative complications remain unclearly described in current literature.

[METHODS] A single reconstructive surgeon retrospective cohort study was conducted on 44 patients (72 breasts) with prior breast augmentation undergoing breast reconstruction following NSM between July 2006 and May 2021. Twenty-nine patients (49 breasts) underwent capsule preservation reconstruction compared with 15 patients (23 breasts) who did not. Demographics, complications, and cosmetic outcomes between the 2 cohorts were reviewed.

[RESULTS] Patients with capsule preservation were on average younger at time of NSM (49 years vs 55 years; P = 0.040) and more likely to undergo 1-stage reconstruction (65.5% vs 13.3%; P = 0.001). Cancer recurrence was similar, though lower in the capsule-preserved group (0% vs 13.3%; P = 0.111). There was no significant difference in regard to postoperative complications, with the exception of seromas being more common in the noncapsule preservation group (47.8% vs 6.1%; P < 0.0001). Revision surgery rates were also higher in the noncapsule preservation group, though not statistically significant (52.2% vs 24.5%; P = 0.061). The capsule-preserved group demonstrated comparable nipple aesthetic and overall cosmesis based on the primary author's subjective review.

[CONCLUSIONS] For patients with prior breast augmentation, preservation of the preexisting capsule during breast reconstruction following NSM is likely safe with no increased risk of cancer recurrence, favorable complication rates, and comparable cosmetic outcomes.