Autologous fat transplantation prior to permanent expander implant breast reconstruction enhances the outcome after two years: a randomized controlled trial.

Radiotherapy is important in breast cancer treatment. A side effect of the treatment is fibrosis that decreases the possibility for a successful breast reconstruction with expanders and with high patient satisfaction with the result. The most common option for mastectomized, irradiated women wishing for a breast reconstruction is autologous tissue transplantation. However, some patients are not suitable for flap surgery. Fifty mastectomized and irradiated women were included in a randomized controlled trial. They underwent breast reconstruction with expanders and were allocated 1:1 to either receive pre-treatment with autologous fat transplantation (AFT) or not. Primary outcomes were frequency of reoperations and complications. Secondary outcomes were number of days in hospital, number of outpatient visits to surgeon or nurse and patient reported outcome as reported with Breast Q. Follow-up time was 2 years. Fifty-two per cent of the intervention group and 68% of the controls underwent reoperations (p = 0.611). Thirty-two per cent of the intervention group and 52% of the controls had complications (p = 0.347). The median number of consultations with the nurse was four in the intervention group and six in the control group (p = 0.002). The AFT patients were significantly more satisfied with their breasts and psychosocial well-being after 2 years. They also had higher increase in satisfaction with breasts, psychosocial well-being, and sexual well-being when comparing baseline with 2 years postoperatively. This randomized controlled trial indicates benefits of AFT prior to breast reconstruction with expanders, especially on patient reported outcome even if the study sample is small.

Improved patient-reported outcomes after autologous fat transplantation and corrective surgery after breast surgery.

BACKGROUND: Autologous fat transplantation (AFT) is being increasingly used to improve the results after breast-conserving surgery and breast reconstruction. However, studies on patient-reported outcomes (PROs) and health-related quality of life (HRQoL) after AFT are scarce. The aim of this prospective longitudinal case-series study was to assess PRO in women who had undergone AFT after surgery for breast cancer or risk-reducing mastectomy. METHODS: Fifty women, who had undergone breast-conserving surgery or breast reconstruction, needing corrective surgery, were consecutively included between 2008 and 2013. A 20-item study-specific questionnaire (SSQ) and the Short Form Health Survey (SF-36) were used pre-operatively and 6 months, 1 year and 2 years post-operatively, to evaluate PRO and HRQoL. RESULTS: The patients underwent three (1-4) AFT procedures, with the injection of 164 ml (median) (range 40-516) fat. Thirty-eight and 34 patients completed the study-specific questionnaire and the SF-36, respectively, both pre-operatively and after 2 years. Sixteen of the 20 items in the SSQ were improved after 2 years, including breast size (p < 0.0001), shape (p < 0.0001), appearance (p < 0.0001), softness of the breast (p = 0.001), pain in the region (p = 0.005), scarring from previous breast surgery (p < 0.001) and willingness to participate in public physical activities (p < 0.001). HRQoL did not largely differ before and after AFT, or between the study group and a reference population. CONCLUSIONS: AFT alone or in combination with other corrective surgical procedures, improved PRO after breast-conserving surgery and breast reconstruction in both irradiated and non-irradiated women.

Autologous Fat Transplantation to the Reconstructed Breast Does not Hinder Assessment of Mammography and Ultrasound: A Cohort Study.

BACKGROUND: Autologous fat transplantation (AFT) to the breast can correct defects and be a part of a breast reconstruction to achieve a better aesthetic result. The impact of AFT on the radiological evaluation and detection of cancer remains unclarified. The aim of this study is to investigate whether AFT induces lasting modifications. METHODS: In the present study, a valuation was performed of 44 breasts from 37 patients examined with mammography and ultrasound before and after autologous fat transplantation. Breast radiologists evaluated the images using a study specific protocol. RESULTS: AFT did not hinder post-operative assessment of mammograms or ultrasound. No detectable changes with serious clinical impact were found after injections of mean 177 ml (34-516) of fat in one to four sessions. The rate of oil cysts was significantly higher after AFT than pre-operatively (2.3 vs. 34.1 % p = 0.0013). Significantly more post-operative oil cysts were detected after injection of larger volumes of fat (144 vs. 243 ml, p = 0.013). No significant differences were found in the post-operative images regarding age at surgery, follow-up time, or time from previous breast surgery. CONCLUSION: AFT does not impair assessment of mammograms and ultrasound in patients who have a history of breast cancer surgery or prophylactic mastectomy.

Postmastectomy breast reconstruction in the irradiated breast: a comparative study of DIEP and latissimus dorsi flap outcome.

BACKGROUND: Autologous tissue transfer is often indicated to achieve improved tissue quality during breast reconstruction after radiotherapy. The authors evaluated satisfaction with postmastectomy breast reconstruction among irradiated patients. The aim was to compare deep inferior epigastric perforator (DIEP) and latissimus dorsi flaps regarding satisfaction with aesthetic outcome between patients and plastic surgeons. METHODS: Patients who underwent reconstruction with 24 consecutive DIEP flaps and 21 consecutive latissimus dorsi flaps in combination with prostheses were reviewed retrospectively. They received the Michigan Outcomes Study 36-Item Short Form Health Survey and a complementary form regarding patient satisfaction. They were photographed, and aesthetic results were evaluated by an independent board of plastic surgeons. RESULTS: There was no significant difference between the groups regarding demographic data or 36-Item Short Form Health Survey results. Plastic surgeons found the DIEP flap superior regarding size (p = 0.024) and shape (p = 0.039), whereas patients were more satisfied with the size (p = 0.046) and shape (p = 0.017) of the latissimus dorsi flap when patients' and surgeons' opinions were compared. Discrepancy between patients' and surgeons' opinions was verified with weighted kappa analysis. Regarding the donor scar, the latissimus dorsi flap was favored compared with DIEP flap reconstruction by both patients (p = 0.036) and surgeons (p = 0.001). CONCLUSIONS: There is a difference between patients' and plastic surgeons' opinions regarding breast reconstruction outcomes in the irradiated breast. The patients were more satisfied with latissimus dorsi flap reconstruction, which may relate to the donor-site scar. Surgeons favored DIEP flap reconstruction with regard to the size and shape of the breast. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Improved shape and consistency after lipofilling of the breast: patients' evaluation of the outcome.

Autologous transplantation of fat, or lipofilling, of the breast can correct deformities after reconstruction and after conservation surgery for cancer. We have made a retrospective evaluation of morbidity and patients' experiences of the method. Forty-four patients have had lipofilling once, twice, or three times (mean transplanted volume 40 ml, range 6-200 ml). One minor complication, a local infection, was treated with antibiotics given orally, and recorded at follow up. A questionnaire was sent to all 44 patients and answered by 43. Twenty-nine of the 43 patients reported improvement of irregularities after lipofilling, 26 reported that the shape of the breast had improved, 26 that the consistency had improved, and 20 that the size had increased postoperatively. Five of the patients reported some adverse effects; one case of liponecrosis that did not need any treatment was found one year postoperatively. No problems were reported at the donor site at follow-up.