Rome, Italy From the Department of Plastic and Reconstructive Surgery, Catholic University of "Sacro Cuore," University Hospital "A. Gemelli."
Plast Reconstr Surg. 2012 Feb;129(2):317-329. doi: 10.1097/PRS.0b013e31822b6619.
In postmastectomy radiated patients, autologous tissue reconstruction is preferred over implant reconstruction, because the latter is associated with a higher rate of postoperative complications. Autologous tissue reconstruction, however, is not always feasible and is sometimes refused by the patient. A challenge also arises in breast-conserving surgery patients seeking breast augmentation with an implant. In this article, the authors present a further reconstructive option for irradiated breast cancer patients consisting of fat grafting followed by implant placement.
The authors retrospectively reviewed 16 cases of irradiated breasts treated with fat grafting and subsequent alloplastic reconstruction/breast augmentation. The evaluation methods were clinical and photography-based assessments. The BREAST-Q was used to quantify patient satisfaction.
Sixteen patients, with a pretreatment Late Effects on Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) score of 1 or 2, underwent two to three fat grafts to achieve a LENT-SOMA score of 0. The placement of the breast implant had been performed in a separate stage at least 3 months after the last grafting session. The average follow-up was 15 months. Reconstructive outcomes were graded from excellent to good in 93.7 percent of patients. Patient satisfaction was marked as high to very high. There were no short-term complications. A Baker grade 1 capsule contracture was found in all patients.
The authors' experience shows that breast fat grafting followed by implant placement may represent a feasible reconstructive option in highly selected patients with irradiated breasts. Fat grafting seems to reduce radiation-induced complications in implants. Larger studies with a longer follow-up are needed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
在接受过乳房切除术和放射治疗的患者中，自体组织重建优于植入物重建，因为后者与更高的术后并发症发生率相关。然而，自体组织重建并非总是可行，有时也会被患者拒绝。对于寻求植入物乳房增大的保乳手术患者，也会出现挑战。在本文中，作者提出了一种针对放射治疗后的乳腺癌患者的进一步重建选择，即脂肪移植后再进行植入物放置。
作者回顾性分析了 16 例接受过脂肪移植和随后的假体重建/乳房增大治疗的放射治疗乳房的病例。评估方法包括临床和基于摄影的评估。使用 BREAST-Q 来量化患者满意度。
16 例患者，预处理后的晚期放射治疗正常组织主观、客观、管理、分析（LENT-SOMA）评分为 1 或 2，接受了 2 至 3 次脂肪移植，以使 LENT-SOMA 评分达到 0。乳房植入物的放置是在最后一次移植后至少 3 个月的单独阶段进行的。平均随访时间为 15 个月。93.7%的患者重建效果评为优秀到良好。患者满意度评为高到非常高。无短期并发症。所有患者均发现贝克分级 1 型包膜挛缩。
作者的经验表明，对于接受过放射治疗的乳房，乳房脂肪移植后再进行植入物放置可能是一种可行的重建选择。脂肪移植似乎可以减少放射治疗对植入物的并发症。需要进行更大规模、随访时间更长的研究。
临床问题/证据水平：治疗性，V。
