Fat Grafting before Delayed Prophylactic Mastectomy and Immediate Implant Reconstruction for Patients at High Risk of Complications

Lesniak, David; Sarfati, Isabelle; Meredith, Ineke; Millochau, Jenny-Claude; Wang, Kuan‐Chi; Nos, Claude; Clough, Krishna B.

doi:10.1097/prs.0000000000008672

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…While mastectomy has been the criterion standard historically, breast conservation therapy (BCT) has emerged as an equally effective treatment. Given the contour deformities that can arise after BCT, autologous fat grafting (AFG) has gained popularity to correct these defects, offering promising results as an innovative reconstructive method with aesthetically pleasing outcomes requiring only a minimally invasive surgery 2,3 …”

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confidence: 99%

“…Given the contour deformities that can arise after BCT, autologous fat grafting (AFG) has gained popularity to correct these defects, offering promising results as an innovative reconstructive method with aesthetically pleasing outcomes requiring only a minimally invasive surgery. 2,3 While AFG offers the potential to correct specific contour deformities after breast procedures and is frequently used as an augment in mastectomy, it is not a standard of care for patients undergoing BCT. Controversy remains regarding the possible long-term implication of autologous fat grafting, particularly relating to cancer recurrence and oncological outcomes-rooted in concern of injecting stem cell containing aliquots into a surgical site that recently housed cancer.…”

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Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy

et al. 2023

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Background Autologous fat grafting (AFG) is often used to reconstruct defects after breast conservation therapy (BCT). However, concerns exist about the possibility of AFG-related recurrence or metastasis. This study aims to evaluate the literature to evaluate oncologic outcomes in patients undergoing AFG at the time of BCT. Methods A systematic review of articles related to AFG based reconstruction at the time of BCT from 1970 to 2021 was performed via PubMed. Patients were grouped based on the presence or lack of AFG usage at the time of BCT, and oncologic outcomes and complications were compared. Results Of the 146 articles identified, 15 were included. Nine hundred patients underwent BCT alone and 1063 patients underwent BCT with AFG patients. Similar average follow-up time was observed between the groups, 58.7 months (BCT only) and 55.2 months (BCT with AFG). On pooled analysis, no difference was identified in local recurrence 4.8% (43 patients) of the BCT group and 3% (32 patients) in the AFG group (P = 0.8), metastasis 4.8% (43 patients) of the BCT group and 6.9% (73 patients) in the AFG group (P = 0.3), or fat necrosis (P = 0.44). Meta-analysis additionally did not identify any statistically significant odds ratios between the BCT only group and BCT with AFG group when evaluated for total recurrence, local recurrence, metastasis or fat necrosis. Conclusions The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting has safe outcomes.

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Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy

et al. 2023

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“…Other studies have demonstrated the positive impact of AFT on both the functional and aesthetic outcomes in breast reconstruction [ 56 ]. AFT has also been used prophylactically to reverse the pathologic effects of RIF in breast tissues prior to breast reconstruction [ 57 , 58 , 59 ]. Ribuffo et al demonstrated that two separate AFT procedures to the breasts 6 weeks after RT and 3 months prior to completion of implant-based breast reconstruction dramatically reduced the rates of skin ulceration and implant exposure [ 58 ].…”

Section: Role Of Fat Grafting In Treating Radiation Induced Fibrosismentioning

confidence: 99%

Deconstructing Fat to Reverse Radiation Induced Soft Tissue Fibrosis

2023

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Adipose tissue is composed of a collection of cells with valuable structural and regenerative function. Taken as an autologous graft, these cells can be used to address soft tissue defects and irregularities, while also providing a reparative effect on the surrounding tissues. Adipose-derived stem or stromal cells are primarily responsible for this regenerative effect through direct differentiation into native cells and via secretion of numerous growth factors and cytokines that stimulate angiogenesis and disrupt pro-inflammatory pathways. Separating adipose tissue into its component parts, i.e., cells, scaffolds and proteins, has provided new regenerative therapies for skin and soft tissue pathology, including that resulting from radiation. Recent studies in both animal models and clinical trials have demonstrated the ability of autologous fat grafting to reverse radiation induced skin fibrosis. An improved understanding of the complex pathologic mechanism of RIF has allowed researchers to harness the specific function of the ASCs to engineer enriched fat graft constructs to improve the therapeutic effect of AFG.

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“…For these patients, the risk of early complications, reconstruction failure, and poor aesthetic results can reach up to 50% [ 77 ]. Carrying out AFG, either before the tissue expander is substituted with the definitive implant or even before the prophylactic mastectomy is performed, significantly improved surgical outcomes [ 78 , 79 , 80 ].…”

Section: Autologous Fat Grafting and Hybrid Prepectoral Reconstructionmentioning

confidence: 99%

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

Weinzierl

Schmauß

Brucato

et al. 2022

JCM

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Over the last years, prepectoral implant-based breast reconstruction has undergone a renaissance due to several technical advancements regarding mastectomy techniques and surgical approaches for the placement and soft tissue coverage of silicone implants. Initially abandoned due to the high incidence of complications, such as capsular contraction, implant extrusion, and poor aesthetic outcome, the effective prevention of these types of complications led to the prepectoral technique coming back in style for the ease of implant placement and the conservation of the pectoralis muscle function. Additional advantages such as a decrease of postoperative pain, animation deformity, and operative time contribute to the steady gain in popularity. This review aims to summarize the factors influencing the trend towards prepectoral implant-based breast reconstruction and to discuss the challenges and prospects related to this operative approach.

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Fat Grafting before Delayed Prophylactic Mastectomy and Immediate Implant Reconstruction for Patients at High Risk of Complications

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 27 publications

Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy

Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy

Deconstructing Fat to Reverse Radiation Induced Soft Tissue Fibrosis

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

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