The effect of radiotherapy on fat engraftment for complete breast reconstruction using lipofilling only

Abstract

Purpose Lipofilling has been established as a standard technique for contour enhancement following breast reconstruction. However, there is a paucity in current literature regarding the use of this technique for complete reconstruction of the female breast as an alternative to conventional techniques, such as expander or flap-based procedures. In particular, the influence of pre-operative irradiation for successful reconstruction has rarely been examined in published studies. Here, the authors describe their experience with successful fat injection in pre-radiated breasts in comparison with non-pre-radiated patients. Methods In this retrospective study, we examined a total of 95 lipofilling treatments on 26 patients (28 breasts). All of them experienced mastectomy following breast cancer; local breast defects after partial resection of the gland were not included in this study. In total, 47 lipofilling procedures in 12 non-irradiated patients (14 breasts) and 48 procedures in 14 irradiated women (also 14 breasts) were performed. Per session, approximately 297 ± 112 cc of adipose tissue was grafted in group A (no radiotherapy) and approximately 259 ± 93 cc was grafted in group B (radiotherapy). Results Among the group of women without pre-operative radiation, 71% of breast reconstructions limited to lipofilling only showed constant engraftment of fat tissue with a successful reconstructive result, whereas only 21% of the patients with pre-radiated breasts showed complete reconstruction of the breast with a permanent fat in-growth. Conclusion Preoperative radiotherapy significantly impedes successful completion of breast reconstructions planned only by autologous fat transfer. Patients should be selected individually and carefully for complete breast reconstruction using lipofilling only.

Letter to the Editor: Comment on Sowa, et al. Patient-reported Outcomes After Autologous Fat grafting in Prosthetic Breast Reconstruction: Prospective Cohort Study Using a Multivariate Analysis (Ann Plast Surg. 2023;90:123–127)

“…In clinical practice, the use of autologous fat grafting to reconstruct breast tissue after radiotherapy has become a prevailing trend, and yet, its safety and effectiveness remain controversial 3 . There are also studies on the effects of radiotherapy on fat graft survival 4 . When the patients in your study are evaluated, it is seen that radiotherapy or chemotherapy is not in the history of all patients.…”