Utilizing large volume fat grafting in breast reconstruction after nipple sparing mastectomies

Abstract

Nipple sparing mastectomy (NSM) has gained popularity especially in prophylactic mastectomies allowing improved cosmetics. Traditionally reconstruction has utilized implants or autologous tissue. With the development of large volume fat grafting additional reconstructive techniques can be utilized in NSM reconstruction. This can either complement a technique or be a standalone form of reconstruction. This paper is intended to serve as a broad overview of fat grafting and its potential role in reconstructing the breast following nipple sparing mastectomies.

Fat Grafting in Breast Reconstruction

“…11 Favorable patient satisfaction outcomes have been proposed with the adjunctive use of autologous fat grafting in patients who undergo IBR after mastectomy. 29,30 In 2017, Qureshi et al conducted a prospective cohort study to evaluate patient-report satisfaction with aesthetic outcomes in patients who underwent direct implant (DTI) placement versus implant placement after tissue expansion (TE/I). The authors found that patients within the TE/I patient cohort who underwent fat grafting reported higher BREAST-Q scores compared with those undergoing TE/I reconstruction without fat grafting (87 AE 17 vs. 66 AE 12; p ¼ 0.02).…”

“…The additional use of fat grafting to the traditional method of implant placement has favorable aesthetic outcomes from both the surgeon's and patient's perspective. 29,30…”

“…2). 28,29 Fat grafting is also useful to ease the contour of the transition between tissue flaps and the native chest wall. 28 Exposure of the internal mammary vessels at the third or fourth interspace, which typically requires excision of the costochondral cartilage at the sternal junction, may exacerbate upper pole concavities that are amenable to correction with secondary fat grafting.…”

“…While fat grafting is most commonly performed as an adjunctive procedure in breast reconstruction to complement autologous tissue flaps and implants, recent studies have shown success with primary reconstruction using fat grafting alone. 29 External expansion is crucial to primary breast reconstruction with fat grafting, with timelines ranging from 6 to 12 hours daily for up to 2 months. 10,29,38 Adipocyte maturation typically takes between 2 to 3 months.…”

“…29 External expansion is crucial to primary breast reconstruction with fat grafting, with timelines ranging from 6 to 12 hours daily for up to 2 months. 10,29,38 Adipocyte maturation typically takes between 2 to 3 months. 39 Therefore, following expansion, fat grafting sessions occur in 3-to 6-month intervals, with the end goal of a breast of natural proportion and supple feel.…”