Fat grafting and breast reconstruction with implant: another option for irradiated breast cancer patients

Abstract

Background: In postmastectomy radiated patients, autologous tissue reconstruction is preferred over implant reconstruction, because the latter is associated with a higher rate of postoperative complications. Autologous tissue reconstruction, however, is not always feasible and is sometimes refused by the patient. A challenge also arises in breast-conserving surgery patients seeking breast augmentation with an implant. In this article, the authors present a further reconstructive option for irradiated breast cancer patients consisting of fat grafting followed by implant placement.

Methods: The authors retrospectively reviewed 16 cases of irradiated breasts treated with fat grafting and subsequent alloplastic reconstruction/breast augmentation. The evaluation methods were clinical and photography-based assessments. The BREAST-Q was used to quantify patient satisfaction.

Results: Sixteen patients, with a pretreatment Late Effects on Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) score of 1 or 2, underwent two to three fat grafts to achieve a LENT-SOMA score of 0. The placement of the breast implant had been performed in a separate stage at least 3 months after the last grafting session. The average follow-up was 15 months. Reconstructive outcomes were graded from excellent to good in 93.7 percent of patients. Patient satisfaction was marked as high to very high. There were no short-term complications. A Baker grade 1 capsule contracture was found in all patients.

Conclusions: The authors' experience shows that breast fat grafting followed by implant placement may represent a feasible reconstructive option in highly selected patients with irradiated breasts. Fat grafting seems to reduce radiation-induced complications in implants. Larger studies with a longer follow-up are needed.

Clinical question/level of evidence: Therapeutic, V.