Advertisement

Aesthetic Plastic Surgery

, Volume 34, Issue 1, pp 5–10 | Cite as

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

  • Marzia Salgarello
  • Giuseppe Visconti
  • Eugenio Farallo
Case Report

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.

Keywords

Breast lipofilling Breast cancer radiotherapy Oncoplastic breast surgery Fat injection in breast Alloplastic breast reconstruction Breast implant 

References

  1. 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–S23PubMedGoogle Scholar
  2. 2.
    Baildam AD (2008) Oncoplastic surgery for breast cancer. Br J Surg 95(1):4–5CrossRefPubMedGoogle Scholar
  3. 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 18:1220–1229PubMedGoogle Scholar
  4. 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 366:2087–2106PubMedGoogle Scholar
  5. 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):661–666CrossRefPubMedGoogle Scholar
  6. 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):347–353CrossRefPubMedGoogle Scholar
  7. 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 97:116–126PubMedGoogle Scholar
  8. 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 82:247–253CrossRefPubMedGoogle Scholar
  9. 9.
    National Comprehensive Cancer Network (NCCN) (2008) Clinical practice guidelines in oncology: breast cancer ver. 1.2009. NCCN, Fort Washington, PAGoogle Scholar
  10. 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. 11.
    Agha-Mohammadi S, De La Cruz C, Hurwitz DJ (2006) Breast reconstruction with alloplastic implants. J Surg Oncol 94(6):471–478CrossRefPubMedGoogle Scholar
  12. 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):877–881CrossRefPubMedGoogle Scholar
  13. 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):19–28CrossRefPubMedGoogle Scholar
  14. 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):859–865PubMedGoogle Scholar
  15. 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):136–142PubMedGoogle Scholar
  16. 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):713–721PubMedGoogle Scholar
  17. 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):1617–1628CrossRefPubMedGoogle Scholar
  18. 18.
    Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg 19:421–425CrossRefPubMedGoogle Scholar
  19. 19.
    Salgarello M, Visconti G, Farallo E (2009) Fat graft in prosthetic and autologous breast reconstruction. J Korean Soc Aesthetic Plast Surg 15(1):85–94Google Scholar
  20. 20.
    Spear SL, Baker JL Jr (1995) Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 96:1119–1123PubMedCrossRefGoogle Scholar
  21. 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):356–362CrossRefPubMedGoogle Scholar
  22. 22.
    Reavey P, McCarthy CM (2008) Update on breast reconstruction in breast cancer. Curr Opin Obstet Gynecol 20(1):61–67CrossRefPubMedGoogle Scholar
  23. 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):78–82CrossRefPubMedGoogle Scholar
  24. 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):1080–1087CrossRefPubMedGoogle Scholar
  25. 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):264–268CrossRefPubMedGoogle Scholar
  26. 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):1292–1298CrossRefPubMedGoogle Scholar
  27. 27.
    Hausman GJ, Richardson RL (2004) Adipose tissue angiogenesis. J Anim Sci 82(3):925–934PubMedGoogle Scholar
  28. 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):1409–1422CrossRefPubMedGoogle Scholar
  29. 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–128SCrossRefPubMedGoogle Scholar
  30. 30.
    Le Blanc K (2003) Immunomodulatory effects of fetal and adult mesenchymal stem cells. Cytotherapy 5(6):485–489CrossRefPubMedGoogle Scholar
  31. 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):118–129CrossRefPubMedGoogle Scholar
  32. 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):435–453PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2009

Authors and Affiliations

  • Marzia Salgarello
    • 1
    • 2
  • Giuseppe Visconti
    • 3
  • Eugenio Farallo
    • 1
  1. 1.Department of Plastic and Reconstructive Surgery, Catholic University of “Sacro Cuore”University Hospital A. GemelliRomeItaly
  2. 2.RomeItaly
  3. 3.Catholic University of “Sacro Cuore”University Hospital A. GemelliRomeItaly

Personalised recommendations