A history of cosmetic breast surgery (CBS) does not increase the risk of surgical complications for women undergoing skin-sparing or nipple-sparing mastectomy with immediate breast reconstruction (IBR). These results were published in Clinical Breast Cancer.

Concerned about the limited information on complications of IBR for patients with breast cancer who had undergone prior CBS, a team of researchers set out to compare IBR outcomes in patients with a history of CBS undergoing skin- or nipple-sparing mastectomy with outcomes in patients with no history of CBS.

Data from 956 mastectomies performed on 697 patients between 2017 and 2019 at a high-volume academic breast surgery program in Florida were analyzed. Of those, 545 mastectomies in 356 patients (median age, 51 years) included IBR.

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Complications were documented in 14.7% of the mastectomies: 9.7% were infections and 7.9% were skin necrosis that required operative intervention. Loss of breast reconstruction occurred in 5.5% of patients.

Patients aged 50 years and older who underwent nipple-sparing mastectomy were more likely to experience complications. Although this procedure can provide improved cosmesis, it does carry a greater risk of complications, which is consistent with previous studies.

“However, prior CBS was not associated with an increased likelihood of developing complications or reconstruction loss,” the researchers reported. “This data supports the safety of mastectomy and IBR in appropriately selected patients who have had prior CBS.”

Due to its retrospective nature, unmeasured confounders and variables not included in the medical record limited information available to the researchers. Information on prior treatments in patients referred from other centers also may not have been available. Generalizability of the results also is not clear, as all the data were obtained from patients within 1 academic medical center program. However, the procedures were performed by multiple breast and plastic surgeons using different surgical techniques, perhaps providing a realistic view of expected complications.

Advances in breast surgical and reconstruction techniques have expanded the options available to women with breast cancer undergoing prophylactic or therapeutic mastectomy. As the popularity of cosmetic surgery grows, more patients with breast cancer undergoing mastectomy will have a history of CBS. These results demonstrate that prior cosmetic procedures do not appear to increase the risk of surgical complications in these patients.


Fiser CK, Kronenfeld JP, Liu SN, et al. Comparison of immediate breast reconstruction outcomes in patients with and without prior cosmetic breast surgery. Clin Breast Cancer. 2022;22(2):136-142. doi:10.1016/j.clbc.2021.07.016