Aesthetic, Hand and Reconstructive Surgery, University Center for Plastic, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany.
Arch Gynecol Obstet. 2023 Feb;307(2):549-555. doi: 10.1007/s00404-022-06610-4. Epub 2022 May 30.
Lipofilling has been established as a standard technique for contour enhancement following breast reconstruction. However, there is a paucity in current literature regarding the use of this technique for complete reconstruction of the female breast as an alternative to conventional techniques, such as expander or flap-based procedures. In particular, the influence of pre-operative irradiation for successful reconstruction has rarely been examined in published studies. Here, the authors describe their experience with successful fat injection in pre-radiated breasts in comparison with non-pre-radiated patients.
In this retrospective study, we examined a total of 95 lipofilling treatments on 26 patients (28 breasts). All of them experienced mastectomy following breast cancer; local breast defects after partial resection of the gland were not included in this study. In total, 47 lipofilling procedures in 12 non-irradiated patients (14 breasts) and 48 procedures in 14 irradiated women (also 14 breasts) were performed. Per session, approximately 297 ± 112 cc of adipose tissue was grafted in group A (no radiotherapy) and approximately 259 ± 93 cc was grafted in group B (radiotherapy).
Among the group of women without pre-operative radiation, 71% of breast reconstructions limited to lipofilling only showed constant engraftment of fat tissue with a successful reconstructive result, whereas only 21% of the patients with pre-radiated breasts showed complete reconstruction of the breast with a permanent fat in-growth.
Preoperative radiotherapy significantly impedes successful completion of breast reconstructions planned only by autologous fat transfer. Patients should be selected individually and carefully for complete breast reconstruction using lipofilling only.
脂肪填充术已被确立为乳房重建后轮廓增强的标准技术。然而，目前关于该技术用于替代传统技术（如扩张器或皮瓣手术）完全重建女性乳房的文献很少。特别是，术前放疗对成功重建的影响在已发表的研究中很少被检查。在这里，作者描述了他们在接受过放疗的乳房中成功进行脂肪注射的经验，并将其与未接受放疗的患者进行了比较。
在这项回顾性研究中，我们共检查了 26 名患者（28 个乳房）的 95 例脂肪填充治疗。所有患者均因乳腺癌接受了乳房切除术；本研究不包括部分切除腺体后的局部乳房缺损。共对 12 名未接受放疗的患者（14 个乳房）进行了 47 次脂肪填充手术，对 14 名接受放疗的女性（也有 14 个乳房）进行了 48 次脂肪填充手术。在 A 组（未接受放疗），每次手术约移植 297±112 cc 的脂肪组织，在 B 组（接受放疗），每次手术约移植 259±93 cc 的脂肪组织。
在未接受术前放疗的女性组中，71%的仅接受脂肪填充的乳房重建显示出脂肪组织持续移植，重建效果成功，而仅 21%的接受过放疗的乳房患者显示出乳房的完全重建，脂肪永久性生长。
术前放疗显著阻碍了仅通过自体脂肪转移计划完成的乳房重建。应根据患者的具体情况，谨慎选择仅用脂肪填充进行完全乳房重建。
