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Randomized Controlled Trial
. 2023 Apr;47(2):593-604.
doi: 10.1007/s00266-022-03076-2. Epub 2022 Sep 13.

Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer vs. Implants

Jamilla L M Wederfoort  1   2 , Alieske Kleeven  3 , Juliette E Hommes  4   5 , Sander M J Van Kuijk  6 , René R W J van der Hulst  4   5 , Andrzej Piatkowski  4   5   7 ; M.D for The Breast trial investigators
Collaborators, Affiliations
Randomized Controlled Trial

Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer vs. Implants

Jamilla L M Wederfoort et al. Aesthetic Plast Surg. 2023 Apr.

Abstract

Background: Autologous fat transfer (AFT) seems to be a new minimal invasive method for total breast reconstruction, yet how patients, surgeons, and laymen evaluate cosmesis is lacking. The aim of this study was to evaluate the aesthetic outcome of AFT (intervention group) for total breast reconstruction post-mastectomy, as compared to implant-based reconstruction (IBR) (control group).

Methods: A random and blinded 3D photographic aesthetic outcome study was performed on a selection of 50 patients, scored by three panels: plastic surgeons, breast cancer patients, and laymen. Secondary outcomes included agreement within groups and possible patient characteristics influencing scoring.

Results: Breast cancer patients and plastic surgeons did not differ in the aesthetic scores between the treatment groups. In contrast, the laymen group scored AFT patients lower than IBR patients (- 1.04, p < 0.001). Remarkably, mean given scores were low for all groups and overall agreement within groups was poor (ICC < 0.50). Higher scores were given when subjects underwent a bilateral reconstruction and if a mamilla was present.

Conclusion: Evaluation of aesthetic outcomes varies greatly. Hence, aesthetic outcome remains a very personal measure and this emphasizes the importance of thorough patient counseling including information on achievable aesthetic results before starting a reconstructive procedure.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Aesthetic outcome; Autologous fat grafting; Breast reconstruction; Cosmetic evaluation; Implants; Lipectomy.

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Figures

Fig. 1.
Fig. 1.
A, B Examples of presented images. The top three images on a slide showed the patient before her breast reconstruction, the lower three images showed the patient 12 months after her final reconstruction. A Female AFT patient, 36 years. B Female IBR patient*, 34 years. *For implant-based reconstruction patients, no images were available directly after mastectomy since a tissue expander (TE) was placed during the same surgery. For these patients, reference images included a tissue expander
See this image and copyright information in PMC

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