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From the “Fat Capsule” to the “Fat Belt”: Limiting Protective Lipofilling on Irradiated Expanders for Breast Reconstruction to Selective Key Areas

  • Original Article
  • Breast Surgery
  • Published:
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Abstract

Background

The number of patients undergoing mastectomy and immediate breast reconstruction with tissue expanders followed by post-mastectomy radiotherapy (PMRT) is exponentially increasing. To reduce the rate of complications, in 2011, the senior author of this manuscript described the use of protective lipofilling in patients undergoing unplanned PMRT to the expander with a specific protocol aiming to decrease the rate of complications.

Objectives

A study was performed to evaluate the thickness of the breast irradiated tissue to create a standard pattern of “protective” lipofilling infiltration on limited key areas that could re-establish a thickness similar to non-radiotreated tissues.

Methods

We studied 15 patients who had modified radical mastectomy (MRM) with immediate breast reconstruction with tissue expanders and PMRT (Group 1) before expansion (Time1), before PMRT (Time2), after PMRT (Time3), 3 months after “protective” lipofilling (Time4), and 6 months after “protective” lipofilling (Time5). As a control group, we studied 15 patients who had MRM and immediate breast reconstruction with tissue expanders that would not undergo PMRT (Group 2) at the same time points of GROUP 1 (Time1,2,3). Tissue thickness was studied in specific areas using ultrasounds (US) and magnetic resonance imaging (MRI).

Results

US and MRI measurements obtained 6 weeks after PMRT and 3 months after lipofilling showed an initial decrease and then an average increase in tissue thickness reaching values even higher than the non-radiotreated control group.

Conclusions

This preliminary report shows how a one-step “fat belt” surgical pattern of lipofilling delivered to central “selected” areas of the breast can achieve adequate tissue thickness in patients who underwent breast reconstruction with PMRT reaching a thickness similar (and in most cases higher) to non-radiotreated tissues. Further follow-up studies are needed to analyze long-term complications of tissue thinning such as ulceration and implant exposure, in comparison with the “fat capsule” pattern.

Level of Evidence IV

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Acknowledgements

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Surgery “Valdoni,” Unit of Plastic and Reconstructive Surgery, “Sapienza” Univesity of Rome, Viale del Policlinico, 155, 00161, Rome, Italy

    Nicola Vaia, Federico Lo Torto, Marco Marcasciano, Donato Casella, Claudia Cacace, Carlo De Masi, Fabio Ricci & Diego Ribuffo

  2. Breast Unit, Department of Oncologic and Reconstructive Breast surgery, “Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda, USL Toscana Nord Ovest”, Livorno, Italy

    Donato Casella

  3. Breast Unit, Santa Maria Goretti Hospital, Sapienza University, Latina, Italy

    Carlo De Masi & Fabio Ricci

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  1. Nicola Vaia
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  2. Federico Lo Torto
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  3. Marco Marcasciano
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  4. Donato Casella
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  8. Diego Ribuffo
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Vaia, N., Lo Torto, F., Marcasciano, M. et al. From the “Fat Capsule” to the “Fat Belt”: Limiting Protective Lipofilling on Irradiated Expanders for Breast Reconstruction to Selective Key Areas. Aesth Plast Surg 42, 986–994 (2018). https://doi.org/10.1007/s00266-018-1120-3

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  • DOI: https://doi.org/10.1007/s00266-018-1120-3

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