Enhancing Breast Reconstruction: An Analysis of 117 Patients Undergoing Delayed Autologous Fat Grafting Enhancing breast reconstruction
Abstract
Background: The number of total mastectomy patients requesting breast reconstruction is increasing. However, many patients refuse this surgery because the procedures are too complex, too prone to complications, or even just because of the fear of breast implants and their long-term consequences. In this study, a comprehensive assessment of the results and complications of only fat grafting breast reconstruction is presented.
Methods: Between 2012 and 2021, 127 fat grafting breast reconstruction was performed in 117 patients who previously received total mastectomy. These included 70 cases of delayed breast reconstruction (DBR) and 57 "conversions," i.e., removal of a reconstructive implant replaced by iterative fat injections. The patients were fully informed about the procedure's risks and benefits before intervention. All the patients signed an informed consent. The procedure, complications, and results were analyzed on a regular basis every 3-6 months (average follow-up of 3 years).
Results: Data from 117 patients with a mean age of 59 years (25-83) were included in this study. The mean body mass index was 23 (19-30). Seventy patients had received radiotherapy before mastectomy (55%). An average of 3.17 injections (2 to 7) with an average volume of 300 cc were required to finalize the breast reconstruction, with a total average injected volume of 933 cc. Simple fat transfers were performed on an outpatient basis except for bilateral or associated procedures. In 48 cases (40%), the patients received appropriate procedures on the contralateral breast to make it symmetrical. Complications happened in 10 percent of cases, mostly minor complications like fatty cysts or much-localized Cytosteatonecrosis though in a limited number of patients, more serious problems with hematomas, abscesses, diffuse Cytosteatonecrosis or very extensive lymphoceles appeared.
Conclusion: The findings of this study support fat transfer breast reconstruction as a safe procedure with acceptably low complications, even in patients who have received radiotherapy in their history. Furthermore, this procedure can be applied in an outpatient setting. It seems that the application and the indications of this easy and feasible procedure will be increased in the coming years.
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References
Geers J, Wildiers H, Van Calster K, Laenen A, Floris G, Vandevoort M, et al. Oncological safety of autologous breast reconstruction after mastectomy for invasive breast cancer. BMC Cancer. 2018 19;18(1):994. doi: 10.1186/s12885-018-4912-6.
Stacey DH, Spring MA, Breslin TM, Rao VK, Gutowski KA. Exploring the effect of the referring general surgeon's attitudes on breast reconstruction utilization. WMJ. 2008;107(6):292-7.
Henry M, Baas C, Mathelin C. Reconstruction mammaire après cancer du sein : les motifs du refus [Why do women refuse reconstructive breast surgery after mastectomy?]. Gynecol Obstet Fertil. 2010;38(3):217-23. French. doi: 10.1016/j.gyobfe.2009.10.003.
Zieliński T, Lorenc-Podgórska K, Antoszewski B. Why women who have mastectomy decide not to have breast reconstruction? Pol Przegl Chir. 2015. 3;86(10):451-5. doi:10.2478/pjs-2014-0081.
Héquet D, Zarca K, Dolbeault S, Couturaud B, Ngô C, Fourchotte V, et al. Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus. 2013. 18;2:325. doi: 10.1186/2193-1801-2-325.
Shamoun F, Asaad M, Hanson SE. Oncologic Safety of Autologous Fat Grafting in Breast Reconstruction. Clin Breast Cancer. 2021;21(4):271-277. doi: 10.1016/j.clbc.2021.01.020.
Li M, Shi Y, Li Q, Guo X, Han X, Li F. Oncological Safety of Autologous Fat Grafting in Breast Reconstruction: A Meta-analysis Based on Matched Cohort Studies. Aesthetic Plast Surg. 2022;46(3):1189-1200. doi: 10.1007/s00266-021-02684-8.
Qiu J, Tang L, Huang L, Hou S, Zhou J. Physical and 289 psychological effects of different temperature-controlled breast prostheses on patients with breast cancer during rehabilitation: a randomized controlled study (CONSORT). Medicine (Baltimore). 2020;99(13):e19616. doi: 10.1097/MD.0000000000019616.
Radu M, Bordea C, Noditi A, Blidaru A. Assessment of Mastectomy Skin Flaps for Immediate Implant-Based Breast Reconstruction. J Med Life. 2018;11(2):137-145.
Gabriel A, Champaneria MC, Maxwell GP. Fat grafting and breast reconstruction: tips for ensuring predictability. Gland Surg. 2015;4(3):232-43. doi: 10.3978/j.issn.2227-684X.2015.04.18.
Illouz YG, Sterodimas A. Autologous fat transplantation to the breast: a personal technique with 25 years of experience. Aesthetic Plast Surg 2009;33:706-15.
Delay E, Streit L, Toussoun G, La Marca S, Ho Quoc C. Lipomodelling: an important advance in breast surgery. Acta Chir Plast. 2013;55(2):34-43.
Razzouk K, Humbert P, Borens B, Gozzi M, Al Khori N, Pasquier J, et al. Skin trophicity improvement by mechanotherapy for lipofilling-based breast reconstruction postradiation therapy. Breast J. 2020;26(4):725-728. doi: 10.1111/tbj.13645.
Kaya B, Serel S. Breast reconstruction. Exp Oncol. 2013;35(4):280-6.
Berti M, Goupille C, Doucet M, Arbion F, Vilde A, Body G, Ouldamer L. Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for cancer: A case control study. J Gynecol Obstet Hum Reprod. 2022;51(1):102257. doi: 10.1016/j.jogoh.2021.102257.
Frey JD, Salibian AA, Karp NS, Choi M. Implant-Based Breast Reconstruction: Hot Topics, Controversies, and New Directions. Plast Reconstr Surg. 2019;143(2):404e-416e. doi: 10.1097/PRS.0000000000005290.
Moran SL, Herceg S, Kurtelawicz K, Serletti JM. TRAM flap breast reconstruction with expanders and implants. AORN J. 2000;7.1(2):354-62; quiz 363-8. doi: 10.1016/s0001-2092(06)62115-7.
Arnez ZM, Khan U, Pogorelec D, Planinsek F. Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity. Br J Plast Surg. 1999;52(5):351-4. doi: 10.1054/bjps.1999.3099.
Blondeel N, Vanderstraeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg. 1997;50(5):322-30. doi: 10.1016/s0007-1226(97)90540-3.
Wu LC, Bajaj A, Chang DW, Chevray PM. Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction. Plast Reconstr Surg. 2008;122(3):702-709. doi: 10.1097/PRS.0b013e3181823c15.
Salmi AM. Breast reconstruction with free transverse rectus abdominis myocutaneous flaps in hospitals unaccustomed to microsurgery: original retrospective study. Scand J Plast Reconstr Surg Hand Surg. 2005;39(3):153-7. doi: 10.1080/02844310410004937.
Tukiama R, Vieira RAC, Moura ECR, Oliveira AGC, Facina G, Zucca-Matthes G, et al. Oncologic safety of breast reconstruction with autologous fat grafting: A systematic review and meta-analysis. Eur J Surg Oncol. 2022;48(4):727-735. doi: 336 10.1016/j.ejso.2021.12.017.
Yoshimoto H, Hamuy R. Breast Reconstruction After Radiotherapy. Adv Wound Care (New Rochelle). 2014. 1;3(1):12-15. doi: 10.1089/wound.2012.0404.
Piffer A, Aubry G, Cannistra C, Popescu N, Nikpayam M, Koskas M, et al. Breast Reconstruction by Exclusive Lipofilling after Total Mastectomy for Breast Cancer: Description of the Technique and Evaluation of Quality of Life. Journal of Personalized Medicine. 2022; 12(2):153. doi:10.3390/jpm12020153
Chung JH, Kim KJ, Jung SP, Park SH, Yoon ES. Analysis of oncological safety of autologous fat grafting after immediate breast reconstruction. Gland Surg. 2021; 10(2):584-594. doi: 10.21037/gs-20-645.
Homsy P, Höckerstedt A, Hukkinen K, Kauhanen S. Total breast reconstruction with lipofilling after traditional mastectomy without the use of tissue expanders. Plast Reconstr Surg. 2023. doi: 10.1097/PRS.0000000000010252.
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