Alshemeili Jasem, Lelala Bruce, Hudson Donald A
From the Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
Division of Plastic and Reconstructive Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Plast Reconstr Surg Glob Open. 2025 May 23;13(5):e6771. doi: 10.1097/GOX.0000000000006771. eCollection 2025 May.
Delayed prosthetic breast reconstruction is commonly undertaken, but after radiotherapy it carries a higher risk of complications. Autologous fat grafting (AFG) improves the quality of the tissue, particularly after radiotherapy. The aim of this study was to assess the role of AFG in patients undergoing delayed breast reconstruction with tissue expanders as the first stage.
This is a retrospective study of 58 patients (mean age 45 y, range 26-62 y) having delayed prosthetic breast reconstruction by tissue expansion as the first stage, at a tertiary hospital between January 2016 and November 2019. History of radiotherapy postmastectomy was recorded. Fifty-eight patients were divided into those who received fat grafting before tissue expander insertion and those who did not. Complications of both groups were analyzed.
Forty-one patients had tissue expanders inserted without fat grafting, whereas 17 patients had fat grafting before tissue expander insertion. Of these 17 patients (10 of whom also had postoperative radiotherapy) who had fat grafting before expander insertion, only 2 developed extrusion; both patients had radiation. Of 41 patients having tissue expansion insertion without fat grafting, 19 patients developed extrusion, and 14 of these 19 patients had radiation therapy.
Clinical assessment of the mastectomy flaps is required before tissue expander insertion, and, if atrophic and scarred from previous infection, or, if the patient has undergone radiotherapy, AFG should be considered. Fat grafting reduced tissue expander extrusion in patients having delayed breast reconstruction, especially in patients who had radiation.
延迟性乳房假体再造较为常见，但放疗后进行该手术会带来更高的并发症风险。自体脂肪移植（AFG）可改善组织质量，尤其是在放疗后。本研究的目的是评估AFG在以组织扩张器作为第一阶段进行延迟性乳房再造患者中的作用。
这是一项对58例患者（平均年龄45岁，范围26 - 62岁）的回顾性研究，这些患者于2016年1月至2019年11月在一家三级医院接受了以组织扩张作为第一阶段的延迟性乳房假体再造。记录了乳房切除术后的放疗史。58例患者被分为在植入组织扩张器前接受脂肪移植的患者和未接受脂肪移植的患者。分析了两组的并发症情况。
41例患者在未进行脂肪移植的情况下植入了组织扩张器，而17例患者在植入组织扩张器前接受了脂肪移植。在这17例在扩张器植入前接受脂肪移植的患者中（其中10例还接受了术后放疗），只有2例发生了扩张器挤出；这2例患者都接受过放疗。在41例未进行脂肪移植而植入组织扩张器的患者中，19例发生了扩张器挤出，其中14例接受过放疗。
在植入组织扩张器前需要对乳房切除皮瓣进行临床评估，如果皮瓣因先前感染而萎缩和瘢痕化，或者患者接受过放疗，则应考虑进行AFG。脂肪移植减少了延迟性乳房再造患者组织扩张器的挤出，尤其是接受过放疗的患者。
