Fat Grafting in Immediate 2-Stage Breast Reconstruction and Radiotherapy

BACKGROUND Radiotherapy has negative impact on reconstructive outcomes, as it increases complications and leads to poorer aesthetic results, especially in immediate 2-stage implant breast reconstruction. METHODS We analyzed a total of 53 patients (mean age, 47 years; range, 32–76) treated between March 2008 and February 2013 who had previously received mastectomy and 1 stage breast reconstruction with an expander placement under pectoralis major and serratus plane (complete sub-muscular pocket). Our study population was subsequently submitted to radiation treatment, for a total dosage of 50 Gy administered in 25 days, starting within 9 weeks from mastectomy and within 6 months if chemotherapy was indicated, according to our oncological guidelines. According to a modified LENT-SOMA scale, we divided cases into 2 subgroups: in the first one, patients received fat grafting during stage II breast reconstruction (31 patients), whereas in more severe cases, patients received fat grafting 3 months before and during stage II breast reconstruction (22 patients; Fig. 1). Mean follow-up was 32 months (range, 12–61).Fig. 1.: Breast unit protocol.For each patient, we analyzed the presence–absence of reconstruction failure (implant removal) and severe capsular contracture (defined as Baker 3 or 4); moreover, we reported implant volume—final expander volume ratio. At 1 year follow-up, we evaluated aesthetic results by photographic assessment performed by 4 independent evaluators (2 plastic surgeons, 1 general surgeon, 1 medical student) analyzing 7 parameters (infra-mammary crease, breast symmetry, volume, contour, scars, skin flap, overall result). In the same control, we evaluated patients satisfaction adopting Breast Q questionnaire. RESULTS In cases, we found a statistically significant difference of -14.34% (P < 0.05) of reconstruction failure and a -2.65% (P = 0.75) difference of severe capsular contracture (Fisher’s exact test). Mean implant volume—final expander volume ratio in case patients—was 81.81% (SD, 14.56), whereas in controls, it was 84.57% (SD, 11.49; P = 0.461). Aesthetic results and patient satisfaction in cases were comparable with those of controls, although overall lower (Wilcoxon test). Analyzing Breast Q, we observed that patients who were not submitted to radiotherapy showed higher scores than cases in both “Satisfaction with Breasts” and “Physical well-being (Chest)”; in “Satisfaction with Outcome” section, we did not detect any difference, whereas in “PsychoSocial Well-Being” section cases showed higher scores than controls. CONCLUSIONS Our results confirm the effectiveness of fat graft to reduce complications and improve reconstructive outcomes and patient satisfaction in immediate 2-stage implant reconstruction with subsequent radiotherapy.1-5 However, further data are needed to support this evidence and certify our protocol. ACKNOWLEDGMENT The authors thank Mrs. Maria Dioguardi in memory of Domenico Dioguardi.

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