NESPS Home  |  Past Meetings
The Northeastern Society of Plastic Surgeons

Back to 2019 Posters


Increasing Volume Affects Short-term Outcomes in Patients Undergoing Autologous Fat Grafting for Breast Reconstruction
Joshua A. David, M.D., Walter J. Joseph, M.D., Sydney R. Coleman, M.D., Carolyn De La Cruz, M.D..
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

BACKGROUND:
Autologous fat grafting (AFG) is increasingly utilized as an adjunct or alternative to traditional breast reconstruction following mastectomy or breast-conserving surgery. Successful implantation of fat is contingent on a favorable recipient site, which is often compromised by neoadjuvant or adjuvant radiation therapy in this population. However, there are few studies evaluating the direct association between injected fat volume and outcomes in breast reconstruction, particularly as it relates to the timing of radiotherapy.
METHODS:
A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify studies that explicitly reported radiotherapy status, lipo-injection volumes, and outcomes for patients undergoing AFG-assisted breast reconstruction. Preoperative variables and outcomes were compared between patients who received radiation prior to AFG (pre-irradiated), subsequent to AFG (post-irradiated), or never exposed to radiation (non-irradiated). Chi-square analysis and Fisher’s exact test were used for categorical variables, t-tests for continuous variables, and ROC for exploratory analyses. Multivariate regression was performed to control for potential confounders.
RESULTS:
Our search identified 1,341 articles, 12 of which were included in the final analysis. Briefly, 115 breasts were analyzed; 51 (44.3%) non-irradiated, 44 (38.3%) pre-irradiated, and 20 (17.4%) post-irradiated. Average total fat volume injected was 354.5 ml per breast (range 50 to 950 ml). Fat injection volume, number of AFG sessions, and duration of AFG treatment did not affect outcomes in non-irradiated or pre-irradiated patients. However, post-irradiated patients experienced a 10-fold short-term complication rate (p<0.05, LR: 10.938, 95% CI 1.024 to 116.842), despite fewer AFG sessions, smaller injection volumes, and a shorter duration of AFG treatment than the other two patient groups. Furthermore, ROC curve analysis (Figure 1) demonstrated that this risk is present with injections as modest as 68 mL, and multiplies 4-fold in excess of 128 mL (p=0.04, 95% CI 0.62-1.0). Long-term complications and graft survival were similar across the three patient groups.
CONCLUSIONS:
Here, we present a systematic review of outcomes following AFG in breast reconstruction, with particular attention to patient radiotherapy status and volumes of injected fat. These results suggest that AFG should be approached with caution or delayed in patients who will receive future radiotherapy, particularly when increased injection volumes are expected. However, in patients who have previously undergone radiation therapy, AFG does not seem to affect short or long-term outcomes when compared to radiation-naïve patients, making it a safe and effective option for breast reconstruction in this population.


Back to 2019 Posters