Total Breast Reconstruction Using Autologous Fat Grafting Following Nipple-Sparing Mastectomy in Irradiated and Non-irradiated Patients
Although autologous microvascular reconstruction following nipple-sparing mastectomy (NSM) is considered one of the best reconstructive choices, this procedure cannot be offered to all patients. The aim of this study was to define a fat grafting protocol for successful reconstruction following NSM and to assess its reliability in irradiated and non-irradiated patients.
Materials and Methods
Twenty-one patients were prospectively enrolled and stratified in Group-A (11 non-irradiated) and Group-B (10 irradiated) NSMs comparing clinical and aesthetic outcomes. A fat grafting protocol was used to standardize the procedure. Continuous and categorical variables were analysed using the Student t test and the Kruskal–Wallis test, respectively. A value of p ≤ 0.05 was considered statistically significant.
The groups were homogeneous in terms of demographics (p > 0.05), while number of sessions, mean volume of the first two treatments, and overall injected volume showed significant differences (p < 0.001; p < 0.001; p = 0.002). Volume, shape, position of the breast mound, IMF and scar location subscales obtained high score evaluations without a significant difference between the groups (p > 0.05), whereas the skin texture subscale showed a lower score evaluation in Group-B than in Group-A (p = 0.001). Although a significant difference for total subscales was in favour of Group-A (p = 0.001), the global score had a high rate evaluation in both groups (p = 0.132). Inter-rater reliability showed substantial agreement among all categories, total and global scores.
To the best of our knowledge, this is the first prospective series of fat transfer reconstructions following NSM using a systematic approach. Although further studies are required, it may be considered an effective option whenever flap reconstruction cannot be performed.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
KeywordsAutologous fat transfer Autologous breast reconstruction Nipple-sparing mastectomy Fat grafting Lipofilling
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Coleman SR, Saboeiro AP (2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 119:775–785; discussion 786–777Google Scholar
- 8.Ross RJ, Shayan R, Mutimer KL, Ashton MW (2013) Autologous fat grafting: current state of the art and critical review. Ann Plast Surg 73:352–357Google Scholar
- 10.Jouglard JPL (1973) Plasties Mammaires pour Hypertrophie et Ptose. Masson et Cie, ParisGoogle Scholar
- 11.Rigotti G, Marchi A, Khouri RK (2009) Minimally invasive autologous mastectomy incisionless reconstruction; external expansion fat grafting and percutaneous scar release: A multicenter experience. In: Paper Presented at 88th Annual Meeting and Symposium of the American Association of Plastic Surgeons; March 24, 2009; Rancho Mirage, CalifGoogle Scholar
- 12.Garbay JR, Rietjens M, Petit JY (1992) Esthetic results of breast reconstruction after amputation for cancer: 323 cases. J Gynecol Obstet Biol Reprod 21:405–412Google Scholar
- 20.Petit JY, Lohsiriwat V, Clough KB, Sarfati I, Ihrai T, Rietjens M et al (2011) The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study-milan-paris-lyon experience of 646 lipofilling procedures. Plast Reconstr Surg 128:341–346PubMedCrossRefGoogle Scholar
- 24.Cutuli B, Fourquet A, Luporsi E et al (2005) Standards, Options and Recommendations for the management of ductal carcinoma in situ of the breast (DCIS): update 2004. Bull Cancer 92:155–168Google Scholar