Abstract Background: With advances in breast cancer surgery, the proportion of breast-conserving surgery (BCS), nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and breast reconstruction has increased compared to the past, when total mastectomy was the predominant approach. The introduction of NSM and SSM has enabled patients with more extensive disease to expect improvements in psychological and emotional recovery, cosmetic satisfaction, and quality of life. However, NSM and SSM are known to have a higher risk of wound complications, such as skin necrosis and infection, compared to BCS or total mastectomy. In particular, previous studies have reported that the risk of ischemic complications increases as the thickness of the skin flap decreases. Recently, due to increasing aesthetic demands and advances in medical technology, implant-based breast augmentation has become more common. Clinically, it is often observed that patients who have undergone breast augmentation with implants tend to have thinner skin flaps due to compression of the breast tissue and subcutaneous fat. Therefore, this study aims to compare the incidence of postoperative wound complications after implant-based breast reconstruction following NSM or SSM between patients with and without a history of implant-based breast augmentation. Methods: In total, 817 breast cancer patients treated with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) followed by implant-based breast reconstruction between March 2019 and March 2025 at Seoul National University Bundang Hospital in South Korea were included in this study. Patients were divided into two groups: those with a history of breast implant augmentation prior to their breast cancer diagnosis (N=53) and those without such a history (N=764). To adjust for confounding variables, 1:4 propensity score matching was performed. Postoperative wound complications were classified as acute (within 4 weeks after surgery) or late (after 4 weeks), and the incidence of seroma, infection, necrosis, bleeding/hematoma, wound dehiscence, and capsular contracture was compared between the two groups using the chi-square test. Results: Using 1:4 propensity score matching, 51 breast cancer patients with pre-existing implants were matched to 175 patients without implants. Patients with pre-existing implants demonstrated numerically higher rates of acute infection (13.7% vs. 5.7%, P=0.108), acute wound dehiscence (5.9% vs. 3.4%, P=0.703), late infection (5.9% vs. 4.6%, P=0.990), and late wound dehiscence (2.0% vs. 1.1%, P=1.000) compared to those without implants. Conversely, patients without implants exhibited numerically higher rates of acute seroma (5.7% vs. 0, P=0.174), acute bleeding (2.9% vs. 2.0%, P=1.000), acute necrosis (1.7% vs. 0, P=0.806), late seroma (2.9% vs. 0, P=0.497), and capsular contracture (11.4% vs. 7.8%, P=0.636). However, none of these differences were statistically significant (all P 0.05). Conclusion: While complication profiles varied between patients with and without pre-existing implants undergoing nipple- or skin-sparing mastectomy with implant-based reconstruction, these differences did not reach statistical significance. With the rising prevalence of breast augmentation, the number of breast cancer patients with pre-existing implants is expected to increase. Careful preoperative assessment and individualized surgical planning are therefore essential. Further large-scale, multi-center studies are needed to validate these findings. Citation Format: S. Jeong. Safety of nipple/skin-sparing mastectomy in breast cancer patients who had breast implants abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-03-10.
S. Jeong (Tue,) studied this question.