The Effect of Fat Grafting on Mastectomy Flap Thickness after Nipple-Sparing Mastectomy: An Objective Analysis of Flap Augmentation using Magnetic Resonance Imaging
Ara A. Salibian, MD, Jordan D. Frey, MD, Mihye Choi, M.D., Nolan S. Karp, MD.
NYU Langone Medical Center, New York, NY, USA.
Mastectomy flap thickness plays a critical role in reconstructive and aesthetic outcomes after nipple-sparing mastectomy (NSM), particularly with prepectoral reconstruction, given a higher risk of implant visibility and palpability. Fat grafting for secondary revision after breast reconstruction is well established and has been advocated as a tool for mastectomy flap augmentation. However, the effects of fat grafting on mastectomy flap thickness remain to be fully elucidated
All breast reconstructions that underwent fat grafting after NSM from 2006 to 2016 with available pre- and post-operative breast magnetic resonance imaging (MRI) data were identified. NSM flap thickness was measured using an average of 12 data points for each MRI. Pre- and post-operative measurements were evaluated and compared with NSMs that did not undergo fat grafting.
Six NSM reconstructions including five tissue expander-based and one abdominally-based autologous reconstruction underwent secondary fat grafting with an average of 107 cc per breast. Average age was 45.7 years and average BMI was 27.0 kg/m2. No NSMs had prior or adjuvant radiation therapy. In this group, there was one ischemic complication (16.7%); an incidence of minor mastectomy flap necrosis. Average follow-up time was 56.5 months.
Average preoperative NSM flap thickness was 10.3 mm. Average postoperative NSM flap thickness at a mean of 15.3 months after fat grafting was 10.7 mm. Notably, flap thickness in one NSM with post-NSM MRI data available pre- and post-fat grafting increased from 5.8 mm to 7.3 mm after fat grafting.
NSM flap thickness after fat grafting was 114.8% of preoperative thickness, with no significant differences in thickness between the two groups (p=0.8388). Conversely, in 19 patients with pre- and post-operative MRI imaging who did not undergo fat grafting, average overall post-operative NSM flap thickness was significantly less than pre-operative flap thickness (68.2%, p<0.0001). NSMs that underwent fat grafting were found to have significantly improved relative post-operative/pre-operative mastectomy flap thickness ratios compared to NSMs without fat grafting (p=0.0003).
Fat grafting of the reconstructed breast after NSM can reliably augment mastectomy flap thickness to pre-ablative values.
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