D8. Preservation of the Peri-prosthetic Capsule Allows Larger Volumes of Fat Transfer After Explantation

PURPOSE: Autologous fat grafting (AFG) offers a solution for maintaining breast contour after explantation. However, small-volume AFG may require multiple sessions and large-volume AFG can lead to fat necrosis. Capsulectomy further reduces breast volume and eliminates a potential fat grafting plane. This study investigates the role of capsular preservation in large-volume AFG after explantation. METHODS: All consecutive patients who underwent explantation with large-volume AFG (>200 mL) from January 2021 to July 2024 were included. Data involved patient demographics, operative details, and postoperative complications. Fat grafts were placed into the soft tissues, with subcapsular deposition if the capsule was preserved. RESULTS: Fifteen patients (30 breasts) with an average BMI of 26.25±4.64 and follow-up of 235±271 days were identified. Capsulectomy was performed in 47% of breasts. Average size of the removed implant was 357±71 mL, and AFG volume was 555±225 (210-1000) mL. AFG volume was 28% greater in the no-capsulectomy group (637±256 vs. 460±139, p<0.03). Two breasts developed dehiscence and infection. Fat necrosis occurred in 4 breasts and resolved with conservative management and was not associated with AFG volume. Four breasts required additional AFG 447±101 days after primary surgery. Breasts that required additional AFG had lower initial graft volumes compared to those who did not (290±55 vs. 595±213, p<0.001). CONCLUSION: Large-volume AFG after explantation is effective for restoration of breast form. Capsular preservation may facilitate larger fat transfers. Lower initial graft volumes may require additional fat grafting.