Long-Term Clinical and Aesthetic Results of a Systematic Fat Transfer Protocol for Total Breast Reconstruction after Nipple-Sparing Mastectomy

Abstract

Background: Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. Methods: One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. Results: Groups were homogeneous for demographics (p > 0.05) but significantly different in number of fat transfer sessions (p < 0.001), mean volume of the first two treatments (p = 0.003), and mean total volume of injected fat (p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups (p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A (p = 0.003). Although a significant difference for total subscales was worse in group A (p = 0.004), the global score had a high rate evaluation in all groups (p = 0.145). Interrater reliability showed substantial agreement among all categories. Conclusion: Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Conversion to Autologous Breast Reconstruction with Latissimus Dorsi and Immediate Fat Grafting in Patients with Previous Implant Failure: An Efficient, Reproducible, and Safe Technique

“…Fat grafting in a previously treated area of carcinoma has not been associated with increased recurrence rates. 27,28 This, together with the great versatility of the technique, has led to the widespread use of lipofilling in breast surgery, been employed as a method for total breast reconstruction, 28,29 combined with implants, 30 to repair the sequelae of breast-conserving surgery 31 or combined with different flaps. 9,32 In our study, almost half of the patients (45%) required no additional surgery to complete the reconstruction.…”

Assessment of Risk Factors for Rupture in Breast Reconstruction Patients with Macrotextured Breast Implants

“…Autologous fat transfers (AFT) represent some of these instances, where infiltration cannulas may result in the accidental BI puncture [ 48 ]. AFT is commonly performed in reconstructive patients, either as adjunct procedure to correct implant-related deformities such as waving and rippling, or to mitigate the outcomes of radiotherapy[ 49 , 50 ]. Of note, out of 77 cases where AFT procedures were performed, 20 cases had implant rupture, and three were specifically found from their surgical report to have puncture sites breaching the implants’ shell with fat tissue collections inside the devices.…”

The Use of Exashapetm Bioshield Pocket in Prepectoral Breast Reconstruction: A Preliminary Experience

“…In recent years, recent studies have shown safety 22 , efficacy, and patient satisfaction following pre-pectoral breast reconstruction 23 ; however, further studies with longer follow-ups are needed to evaluate longterm outcomes. Mastectomy had increased in rate thanks to various factors such as better detection of multicentric tumors, widespread prophylactic mastectomies and improved quality of breast reconstruction [24][25][26] . Immediate breast reconstruction has been shown not to affect cancer recurrence or survival, but to improve patients' quality of life 27,28 especially at a psychological level.…”