Wenger Robert, Retrouvey Helene, Metcalfe Kelly, Semple John L
From the Division of Plastic and Reconstructive Surgery, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada.
Women's College Research Institute, Toronto, Ontario, Canada.
Plast Reconstr Surg Glob Open. 2023 Jul 12;11(7):e5119. doi: 10.1097/GOX.0000000000005119. eCollection 2023 Jul.
Two-stage alloplastic breast reconstruction in patients having received mastectomy and radiation is associated with a high rate of complications. Fat grafting has been shown to mitigate the effects of radiation on the chest wall to allow for alloplastic reconstruction. In this study, we assess the outcomes (after a mean follow-up of 28 months), including complications and revisional procedures, of women who had fat grafting to the radiated chest wall before two-stage implant-based breast reconstruction.
A retrospective chart review was performed on consecutive patients seeking delayed implant-based reconstruction after simple mastectomy and postmastectomy radiation therapy between 2011 and 2015. All patients underwent two sessions of fat grafting to the radiated chest wall before inserting a tissue expander and subsequent exchange to a silicone implant.
Twenty patients were included in the study. No reconstructive failures were recorded. The short-term complication rate was 5%, with one hematoma leading to a revisional procedure. The mean follow-up after reconstruction was 28 months. During follow-up, two patients (10%) developed capsular contracture grade IV with implant malposition, leading to capsular revision and implant exchange. Four patients (20%) underwent additional fat grafting for contour deformities.
Fat grafting before two-stage alloplastic breast reconstruction in patients treated with mastectomy and postmastectomy radiation therapy may provide an alternate method of alloplastic reconstruction in a select group of patients who are not suitable for autogenous reconstruction. Follow-up data show that additional surgery may be required for correction of implant malposition and capsular contracture.
接受乳房切除术和放疗的患者进行两阶段异体乳房重建，并发症发生率较高。脂肪移植已被证明可减轻放疗对胸壁的影响，从而允许进行异体重建。在本研究中，我们评估了在两阶段基于植入物的乳房重建前对放疗后的胸壁进行脂肪移植的女性患者的结局（平均随访28个月），包括并发症和修复手术情况。
对2011年至2015年间因单纯乳房切除术和乳房切除术后放疗而寻求延迟植入物重建的连续患者进行回顾性病历审查。所有患者在插入组织扩张器并随后更换为硅胶植入物之前，均对放疗后的胸壁进行了两期脂肪移植。
20名患者纳入研究。未记录到重建失败情况。短期并发症发生率为5%，1例血肿导致进行修复手术。重建后的平均随访时间为28个月。随访期间，2例患者（10%）出现IV级包膜挛缩伴植入物移位，导致包膜修复和植入物更换。4例患者（20%）因外形畸形接受了额外的脂肪移植。
对于接受乳房切除术和乳房切除术后放疗的患者，在两阶段异体乳房重建前进行脂肪移植，可能为一组不适合自体重建的特定患者提供异体重建的替代方法。随访数据表明，可能需要额外的手术来纠正植入物移位和包膜挛缩。
