Impact of fat grafting the chest wall prior to implant reconstruction in high risk patients.

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Abstract Abstract #4143 Background: Breast reconstruction with implants in patients that have either received chest wall irradiation or have relatively thin mastectomy skin flaps carry a higher risk of short and long term failure compared to patients undergoing autologous reconstructions. Patients treated with chest wall irradiation are at highest risk of complications, ranging from 30.2% to 37% and 9.2% to 68% respectively. Improvement in the complication rates in patients identified at higher risk can be achieved through either sequential or singular fat grafts to the subcutaneous tissue of the chest wall prior to implant reconstruction.
 Material and Methods: Patients undergoing implant reconstruction identified through either a history of chest wall irradiation or thin tissue coverage of the chest on physical exam were considered candidates for pre-reconstruction fat grafting. After grafting and completion of implant reconstruction the patients were followed prospectively for a mean of 6 months to evaluate for both early and late complication rates as well as the aesthetic outcome. The lipo-aspirate used in grafting was obtained from either the abdomen or inner thigh areas. The components of the aspirate were then separated by centrifugation at a rate of 3000rpm for 3 minuets. Isolated fat component was injected into both the subcutaneous tissue and retro-muscular plane.
 Results: There were 9 patients that had pre-operative lipofilling prior to implant reconstruction. Of these patients 3 underwent radiation to the skin overlying the chest wall and the remaining 6 had poor chest wall tissue coverage. Follow-up length ranged from 3 – 12 months. During the course of treatment no patients had either short (<2 months) or long term (>2 months) complications that involved: infection, seroma, hematoma, and skin flap necrosis. Revision surgery was performed in 1 patient 2 months after reconstruction due to implant malrotation. Both patient and surgeon satisfaction with the overall breast shape and appearance was good to very good. None of the patients had a local recurrence of their cancer during the follow-up interval nor complications related to the lipofilling procedures.
 Conclusion: Fat grafting prior to delayed implant reconstruction can decrease complication rates and improve cosmetic outcome in high risk patients. The improvement seen with fat grafting may be attributed to increased thickness and improved vascularity of the overlying subcutaneous tissue and skin. The real and theoretical complications of fat grafting such as the oncogenic potential of the lipo-aspirate in patients with a history of breast cancer needs further consideration.
 1 Krueger EA, Wilkins EG, Pierce LJ, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiation Oncology Biol Phys 2001;49(3):713-721.
 2 Clough KB, O'Donoghue JM, Fitoussi AD, Nos C, Falcou MC. Prospective evaluation of late cosmetic results following breast reconstruction: I. implant reconstruction. Plast Reconstr Surg. 2001;107(7):1702-9. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4143.