Background:.Two-stage alloplastic breast reconstruction in patients having received mastectomy and radiation is associated with a high rate of complications.Fat grafting has been shown to mitigate the effects of radiation on the chest wall to allow for alloplastic reconstruction.In this study, we assess the outcomes (after a mean follow-up of 28 months), including complications and revisional procedures, of women who had fat grafting to the radiated chest wall before two-stage implant-based breast reconstruction.
Methods:.A retrospective chart review was performed on consecutive patients seeking delayed implant-based reconstruction after simple mastectomy and postmastectomy radiation therapy between 2011 and 2015.All patients underwent two Clevis Cover sessions of fat grafting to the radiated chest wall before inserting a tissue expander and subsequent exchange to a silicone implant.Results:.
Twenty patients were included in the study.No reconstructive failures were recorded.The short-term complication rate was 5%, with one hematoma leading to a revisional Protection procedure.The mean follow-up after reconstruction was 28 months.
During follow-up, two patients (10%) developed capsular contracture grade IV with implant malposition, leading to capsular revision and implant exchange.Four patients (20%) underwent additional fat grafting for contour deformities.Conclusions:.Fat grafting before two-stage alloplastic breast reconstruction in patients treated with mastectomy and postmastectomy radiation therapy may provide an alternate method of alloplastic reconstruction in a select group of patients who are not suitable for autogenous reconstruction.
Follow-up data show that additional surgery may be required for correction of implant malposition and capsular contracture.