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Autologous Fat Graft in Radiated Tissue Prior to Alloplastic Reconstruction of the Breast: Report of Two Cases

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Abstract

Background

The new indications for radiotherapy in the cure of breast cancer lead to an increasing number of candidates for this adjuvant treatment. However, it raises some concerns with respect to the prosthetic reconstruction of the breast. In fact, the use of implants in the irradiated breast is discouraged by many authors because of the high rate of complications. In these cases autologous tissue reconstruction is being recommended. However, not every patient is a candidate for autologous tissue reconstruction. Furthermore, not all radiotherapies are comparable in dose, timing, and patient tolerance. In this article we present the preliminary results of an alternative surgical management in oncoplastic breast surgery consisting of fat injections before implant placement.

Methods

Six months after the last radiation treatment, a lumpectomy patient and a modified radical mastectomy patient each underwent two sessions of fat injection prior to implant placement, with a 3-month interval in between sessions. The implants were placed 3 months after the last fat injection.

Results

There was a 12-month follow-up for the modified radical mastectomy case and a 18-month follow-up for the lumpectomy case. In both cases we report no postoperative complications, Baker grade 1 capsule contracture, good aesthetic outcome, and high patient satisfaction.

Conclusion

The preliminary results show that fat injection in irradiated tissue prior to breast alloplastic reconstruction may reduce the radiation-related complications on implants. Benefits from fat grafting are in keeping with the theoretical basis of this surgery. Larger studies are needed to confirm our observations.

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References

  1. Association of Breast Surgery at BASO, Association of Breast Surgery at BAPRAS, Training Interface Group in Breast Surgery, Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, Gooch H, Harcourt D, Martin L, Rainsbury D, Rayter Z, Sheppard C, Smith J, Weiler-Mithoff E E, Winstanley J, Church J (2007) Oncoplastic breast surgery–a guide to good practice. Eur J Surg Oncol 33(Suppl 1):S1–S23

    PubMed  Google Scholar 

  2. Baildam AD (2008) Oncoplastic surgery for breast cancer. Br J Surg 95(1):4–5

    Article  CAS  PubMed  Google Scholar 

  3. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220–1229

    CAS  PubMed  Google Scholar 

  4. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 366:2087–2106

    CAS  PubMed  Google Scholar 

  5. Sautter-Bihl ML, Budach W, Dunst J, Feyer P, Haase W, Harms W, Sedlmayer F, Souchon R, Wenz F, Sauer R, Sauer R; German Society of Radiation Oncology; German Cancer Society (2007) DEGRO practical guidelines for radiotherapy of breast cancer I: breast-conserving therapy. Strahlenther Onkol 183(12):661–666

    Article  PubMed  Google Scholar 

  6. Sautter-Bihl ML, Souchon R, Budach W, Sedlmayer F, Feyer P, Harms W, Haase W, Dunst J, Wenz F, Sauer R (2008) DEGRO practical guidelines for radiotherapy of breast cancer II Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease. Strahlenther Onkol 184(7):347–353

    Article  PubMed  Google Scholar 

  7. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, Knowling MA, Coppin CM, Weir L, Gelmon K, Le N, Durand R, Coldman AJ, Manji M (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 97:116–126

    PubMed  Google Scholar 

  8. Overgaard M, Nielsen HM, Overgaard J (2007) Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol 82:247–253

    Article  PubMed  Google Scholar 

  9. National Comprehensive Cancer Network (NCCN) (2008) Clinical practice guidelines in oncology: breast cancer ver. 1.2009. NCCN, Fort Washington, PA

    Google Scholar 

  10. SUPREMO, an MRC Phase III randomised trial to assess the role of adjuvant chest wall irradiation in ‘intermediate risk’ operable breast cancer following mastectomy. Available at http://www.controlled-trials.com/ISRCTN61145589. Accessed 4–11 Jan 2009

  11. Agha-Mohammadi S, De La Cruz C, Hurwitz DJ (2006) Breast reconstruction with alloplastic implants. J Surg Oncol 94(6):471–478

    Article  PubMed  Google Scholar 

  12. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K (2004) Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113(3):877–881

    Article  PubMed  Google Scholar 

  13. Sullivan SR, Fletcher DR, Isom CD, Isik FF (2008) True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg 122(1):19–28

    Article  CAS  PubMed  Google Scholar 

  14. Jhaveri JD, Rush SC, Kostroff K, Derisi D, Farber LA, Maurer VE, Bosworth JL (2008) Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction. Int J Radiat Oncol Biol Phys 72(3):859–865

    PubMed  Google Scholar 

  15. Tallet AV, Salem N, Moutardier V, Ananian P, Braud AC, Zalta R, Cowen D, Houvenaeghel G (2003) Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Radiat Oncol Biol Phys 57(1):136–142

    PubMed  Google Scholar 

  16. Krueger EA, Wilkins EG, Strawderman M, Cederna P, Goldfarb S, Vicini FA, Pierce LJ (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721

    CAS  PubMed  Google Scholar 

  17. Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, Strom EA, Robb GL (2004) Delayed-immediate breast reconstruction. Plast Reconstr Surg 113(6):1617–1628

    Article  PubMed  Google Scholar 

  18. Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg 19:421–425

    Article  CAS  PubMed  Google Scholar 

  19. Salgarello M, Visconti G, Farallo E (2009) Fat graft in prosthetic and autologous breast reconstruction. J Korean Soc Aesthetic Plast Surg 15(1):85–94

    Google Scholar 

  20. Spear SL, Baker JL Jr (1995) Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 96:1119–1123

    Article  CAS  PubMed  Google Scholar 

  21. Chang DW, Barnea Y, Robb GL (2008) Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plast Reconstr Surg 122(2):356–362

    Article  CAS  PubMed  Google Scholar 

  22. Reavey P, McCarthy CM (2008) Update on breast reconstruction in breast cancer. Curr Opin Obstet Gynecol 20(1):61–67

    Article  PubMed  Google Scholar 

  23. Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108(1):78–82

    Article  CAS  PubMed  Google Scholar 

  24. Anderson PR, Hanlon AL, Fowble BL, McNeeley SW, Freedman GM (2004) Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy. Int J Radiat Oncol Biol Phys 59(4):1080–1087

    Article  PubMed  Google Scholar 

  25. McCormick B, Wright J, Cordiero P (2008) Breast reconstruction combined with radiation therapy: long-term risks and factors related to decision making. Cancer J 14(4):264–268

    Article  PubMed  Google Scholar 

  26. Rehman J, Traktuev D, Li J, Merfeld-Clauss S, Temm-Grove CJ, Bovenkerk JE, Pell CL, Johnstone BH, Considine RV, March KL (2004) Secretion of angiogenic and antiapoptotic factors by human adipose stromal cells. Circulation 109(10):1292–1298

    Article  PubMed  Google Scholar 

  27. Hausman GJ, Richardson RL (2004) Adipose tissue angiogenesis. J Anim Sci 82(3):925–934

    CAS  PubMed  Google Scholar 

  28. Rigotti G, Marchi A, Galiè M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119(5):1409–1422

    Article  CAS  PubMed  Google Scholar 

  29. Moseley TA, Zhu M, Hedrick MH (2006) Adipose-derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg 118(3 Suppl):121S–128S

    Article  CAS  PubMed  Google Scholar 

  30. Le Blanc K (2003) Immunomodulatory effects of fetal and adult mesenchymal stem cells. Cytotherapy 5(6):485–489

    Article  CAS  PubMed  Google Scholar 

  31. Puissant B, Barreau C, Bourin P, Clavel C, Corre J, Bousquet C, Taureau C, Cousin B, Abbal M, Laharrague P, Penicaud L, Casteilla L, Blancher A (2005) Immunomodulatory effect of human adipose tissue-derived adult stem cells: comparison with bone marrow mesenchymal stem cells. Br J Haematol 129(1):118–129

    Article  PubMed  Google Scholar 

  32. Bernstein EF, Sullivan FJ, Mitchell JB, Salomon GD, Glatstein E (1993) Biology of chronic radiation effect on tissues and wound healing. Clin Plast Surg 20(3):435–453

    CAS  PubMed  Google Scholar 

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Correspondence to Marzia Salgarello.

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Salgarello, M., Visconti, G. & Farallo, E. Autologous Fat Graft in Radiated Tissue Prior to Alloplastic Reconstruction of the Breast: Report of Two Cases. Aesth Plast Surg 34, 5–10 (2010). https://doi.org/10.1007/s00266-009-9367-3

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  • DOI: https://doi.org/10.1007/s00266-009-9367-3

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