Outcomes in Hybrid Breast Reconstruction: A Systematic Review

Abstract

Background and Objectives: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting has been used as a single reconstructive technique, as well as in combination with other procedures. The aim of the present study is to systematically review available studies in the literature describing the combination of implant-based breast reconstruction and fat grafting, focusing on safety, complications rate, surgical sessions needed to reach a satisfying reconstruction, and patient-reported outcomes. Materials and Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol. A systematic review of the literature up to April 2022 was performed using Medline, Embase, and Cochrane Library databases. Only studies dealing with implant-based breast reconstruction combined with fat grafting were included. Results: We screened 292 articles by title and abstract. Only 48 articles were assessed for full-text eligibility, and among those, 12 studies were eventually selected. We included a total of 753 breast reconstructions in 585 patients undergoing mastectomy or demolitive breast surgeries other than mastectomy (quadrantectomy, segmentectomy, or lumpectomy) due to breast cancer or genetic predisposition to breast cancer. Overall, the number of complications was 60 (7.9%). The mean volume of fat grafting per breast per session ranged from 59 to 313 mL. The mean number of lipofilling sessions per breast ranged from 1.3 to 3.2. Conclusions: Hybrid breast reconstruction shows similar short-term complications to standard implant-based reconstruction but with the potential to significantly decrease the risk of long-term complications. Moreover, patient satisfaction was achieved with a reasonably low number of lipofilling sessions (1.7 on average).

Kite Mastopexy: Small Scar and Tissue-conserving Technique

“…These are all common concerns for the patient and surgeons. 19–21 We believe our technique might reduce both surgical time and postoperative convalescence, as it avoids additional tissue resection and closures. By reducing trauma to the tissues, we may also indirectly reduce the need for postoperative use of narcotics, which has been a critical issue in plastic surgery in recent decades.…”

Bovine Acellular Dermal Matrix–Based Breast Reconstruction in Previously Irradiated Breasts

“…Autologous breast reconstruction seams preferable in this context; however, some patients continue to undergo implant-based reconstruction or hybrid reconstruction despite the risks of radiation, due to either patient choice or lack of tissue for autologous options. 26,27 Recently, implant-based breast reconstruction has evolved to include ADM to provide soft tissue coverage of soft tissue coverage of the lower pole of the breast. 6 Since then, several studies have investigated ADM, both in direct-to-implant and 2-stage surgical reconstructions, reporting low complication rates and better aesthetic results than heterologous reconstruction without ADM, attesting to the reliability and A-D, Preoperative picture, preoperative planning, and postoperative picture of a patient submitted to right nipple-sparing mastectomy after a local recurrence of a previous quadrantectomy followed by RT.…”

“…Autologous breast reconstruction seams preferable in this context; however, some patients continue to undergo implant-based reconstruction or hybrid reconstruction despite the risks of radiation, due to either patient choice or lack of tissue for autologous options 26,27 …”