Barone Adesi Liliana, Taraschi Federico, Macrì Giulia, Scardina Lorenzo, Di Leone Alba, Franceschini Gianluca, Salgarello Marzia
UO Chirurgia Plastica, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS-Università Cattolica del "Sacro Cuore"-Largo A. Gemelli 8, 00168 Rome, Italy.
Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS-Università Cattolica del "Sacro Cuore"-Largo A. Gemelli 8, 00168 Rome, Italy.
J Clin Med. 2024 Aug 23;13(17):4982. doi: 10.3390/jcm13174982.
Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture and implant migration, compared to the traditional submuscular technique, these patients have higher rates of long-term complications when compared with nonradiated patients. This study evaluates the protective effects of autologous fat grafting to reduce long-term radiotherapy-induced complications in breast cancer patients submitted for prepectoral reconstruction with polyurethane-covered (PU) implants. A pilot study with two parallel cohorts of patients undergoing an NSM or SSM followed by PMRT was conducted. Patients were randomly assigned to either of the two groups to ensure homogeneity. One cohort underwent autologous fat grafting sessions, individually tailored based on periodic evaluations by the principal investigator (PI), M. Salgarello, at least six months after PMRT. The control group received standard clinical follow-ups without fat grafting. Inclusion criteria ensured participants were disease-free, non-smokers, and had a LENT-SOMA score within 2. Preliminary findings indicate significant differences between the groups, with improved outcomes observed in patients undergoing tailored lipofilling. Specifically, these patients experienced a notable reduction in capsular contracture severity and reported higher satisfaction with the aesthetic results compared to the control group. Autologous fat grafting, customized per patient by the PI based on ongoing evaluations, appears to mitigate some adverse effects of radiotherapy in prepectoral breast reconstruction, suggesting a viable option for enhancing surgical outcomes in irradiated patients. Further research is needed to substantiate these findings and evaluate long-term benefits.
乳腺癌治疗越来越多地采用保乳根治术后即刻胸前区假体重建，包括保留乳头（NSM）和保留皮肤乳房切除术（SSM）。尽管近期文献数据显示，与传统胸大肌下技术相比，胸前区重建术后的乳房切除术后放疗（PMRT）具有良好的临床效果，可减少包膜挛缩和假体移位，但与未接受放疗的患者相比，这些患者的长期并发症发生率更高。本研究评估自体脂肪移植对降低接受聚氨酯包膜（PU）假体胸前区重建的乳腺癌患者长期放疗所致并发症的保护作用。进行了一项前瞻性研究，将患者分为两个平行队列，分别接受NSM或SSM，随后进行PMRT。患者被随机分配到两组中的任意一组以确保同质性。一组在PMRT至少六个月后，根据主要研究者（PI）M. Salgarello的定期评估进行个体化自体脂肪移植。对照组接受标准临床随访，不进行脂肪移植。纳入标准确保参与者无疾病、不吸烟，且LENT-SOMA评分在2分以内。初步研究结果表明两组之间存在显著差异，接受个体化脂肪填充的患者预后改善。具体而言，与对照组相比，这些患者包膜挛缩严重程度显著降低，对美学效果的满意度更高。PI根据持续评估为每位患者定制的自体脂肪移植，似乎减轻了胸前区乳房重建中放疗的一些不良反应，这表明这是改善放疗患者手术效果的一个可行选择。需要进一步研究来证实这些发现并评估长期益处。
