From the Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University Medical Center.
Plast Reconstr Surg. 2020 Dec;146(6):1227-1236. doi: 10.1097/PRS.0000000000007327.
BACKGROUND: Fat grafting to the reconstructed breast may result in the development of benign lesions on physical examination, prompting further investigation with imaging and biopsy. The aim of this study was to assess the influence of fat grafting on the incidence of imaging and biopsies after postmastectomy reconstruction. METHODS: Patients who underwent autologous or implant-based reconstruction following mastectomy from 2010 to 2018 were identified. Those receiving fat grafting as part of their reconstructive course were propensity matched 1:1 to those that did not with body mass index, reconstruction timing, and reconstruction type as covariates in a multivariable logistic regression model. RESULTS: A total of 186 patients were identified, yielding 93 propensity-matched pairs. Fat-grafted patients had higher incidences of palpable masses (38.0 percent versus 18.3 percent; p = 0.003) and postreconstruction imaging (47.3 percent versus 29.0 percent; p = 0.01), but no significant difference in the number of biopsies performed (11.8 percent versus 7.5 percent; p = 0.32). Imaging was predominately interpreted as normal (Breast Imaging-Reporting and Data System 1, 27.9 percent) or benign (Breast Imaging-Reporting and Data System 2, 48.8 percent), with fat necrosis being the most common finding [n = 20 (45.5 percent)]. No demographic, oncologic, reconstructive, or fat grafting-specific variables were predictive of receiving postreconstruction imaging on multivariate analysis. Fat grafting was not associated with decreased 5-year overall survival or locoregional recurrence-free survival. CONCLUSIONS: Fat grafting to the reconstructed breast is associated with increased incidences of palpable masses and subsequent postreconstruction imaging with benign radiographic findings. Although the procedure is oncologically safe, both patients and providers should be aware that concerning physical examination findings can be benign sequelae of fat grafting and may lead to increased imaging after breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景：脂肪移植到重建后的乳房可能导致体检时出现良性病变，从而需要进一步进行影像学检查和活检。本研究旨在评估脂肪移植对乳腺癌根治术后重建后影像学检查和活检的发生率的影响。
方法：回顾性分析 2010 年至 2018 年期间接受乳腺癌根治术后自体或假体乳房重建的患者。将接受脂肪移植的患者与未接受脂肪移植的患者按照体重指数、重建时间和重建类型进行 1:1 倾向评分匹配，采用多变量逻辑回归模型进行分析。
结果：共纳入 186 例患者，其中 93 例患者进行了倾向评分匹配。脂肪移植组患者可触及肿块的发生率（38.0%比 18.3%；p=0.003）和重建后影像学检查的发生率（47.3%比 29.0%；p=0.01）较高，但活检例数无显著差异（11.8%比 7.5%；p=0.32）。影像学检查主要表现为正常（乳腺影像报告和数据系统 1 级，27.9%）或良性（乳腺影像报告和数据系统 2 级，48.8%），最常见的表现为脂肪坏死（20 例，45.5%）。多变量分析显示，无任何人口统计学、肿瘤学、重建或脂肪移植特异性因素与重建后接受影像学检查相关。脂肪移植与 5 年总生存率或局部区域无复发生存率无关。
结论：脂肪移植到重建后的乳房与可触及肿块的发生率增加以及随后的重建后影像学检查呈良性放射学表现有关。尽管该手术在肿瘤学上是安全的，但患者和医生都应该意识到，令人担忧的体检结果可能是脂肪移植的良性后遗症，并可能导致乳房重建后增加影像学检查。
临床问题/证据水平：治疗性，III 级。
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