Safety of Breast Neurotization Using Nerve Allografts in Implant-Based Breast Reconstruction

BACKGROUND: Breast neurotization has been proposed as a strategy to restore sensation following implant-based breast reconstruction. Although early studies demonstrate promising sensory outcomes, the safety of nerve grafting in this setting has not been evaluated at scale. This study examines whether breast neurotization using nerve allografts is associated with increased postoperative complications following implant-based breast reconstruction. METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Female patients aged 18 years and older undergoing mastectomy with immediate implant-based breast reconstruction between 2006 and 2026 were identified. Patients were stratified into cohorts based on the presence or absence of neurorrhaphy using nerve allografts at the time of reconstruction. Propensity score matching (1:1) was performed using demographics, body mass index, comorbidities, chemotherapy history, and radiation therapy history. Postoperative complications were analyzed at 6 months, 1 year, and 3 years. Major complications included surgical site complications, infection, wound disruption, explantation, capsular contracture, and return to the emergency department or hospital readmission. RESULTS: A total of 35,173 patients were identified, including 759 patients who underwent breast neurotization. After 1:1 matching, 759 patients remained in each cohort with balanced baseline characteristics. No significant differences in rates of major complications were observed between the nerve graft and control cohorts at any time point. CONCLUSIONS: In the largest comparative analysis to date, breast neurotization using nerve allografts during implant-based reconstruction was not associated with increased postoperative morbidity. These findings support the safety of incorporating sensory restoration techniques into implant-based breast reconstruction in appropriately selected patients.