Outcomes of Prosthetic Reconstruction of Irradiated and Nonirradiated Breasts with Fat Grafting

Background: Fat grafting may be beneficial in prosthetic reconstruction of irradiated tissues, but there is a paucity of data on the complication rates associated with this clinical scenario. Methods: All consecutive patients who had undergone fat grafting and prosthetic reconstruction from 2010 to 2013 were enrolled. Variables obtained related to fat grafting and history of irradiation. Implant-related complications in relation to irradiation status were also noted. Results: Eighty-five patients (age 49 ± 10 years) underwent 117 fat grafting procedures. The mean follow-up was 2.6 ± 0.7 years. Fat grafting was predominantly performed to correct soft-tissue deficiency [112 of 117 (95.7 percent)] or to alter skin after irradiation [five of 117 (4.3 percent)]. Thirty-two procedures (27.4 percent) were associated with a complication, with the most common being palpable fat necrosis (23.1 percent). Volume of transferred fat averaged 151.2 ± 76.6 ml per breast. Fat grafting complications did not depend on donor site, technique of fat processing, volume of transferred fat, number of procedures, or irradiation. Implant-related complications were observed after 26 of 117 overall procedures (22.2 percent). No association between implant-related complications and irradiation was observed (OR, 1.3; 95 percent CI, 0.4 to 4.1; p = 0.63). Overall complications following fat grafting in nonirradiated [37 of 82 (45.1 percent)] and irradiated [16 of 35 (45.7 percent)] breasts were not statistically different (OR, 1.02; 95 percent CI, 0.41 to 2.57; p = 0.96). Conclusion: Similar outcomes of irradiated and nonirradiated prosthetic breast reconstruction can be achieved with additional fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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