Surgical Outcomes of Simultaneous Fat Grafting During Tissue Expander-to-Implant Exchange: Is it Safe? A Propensity Score-Matched Analysis
Safi Ali-Khan1, Joseph M. Escandón1, Keith Sweitzer1, Jose G Christiano1, Anna C Weiss1, Howard N. Langstein1, Oscar J. Manrique1
1University of Rochester Medical Center, Rochester, NY
Purpose: Implant-based breast reconstruction (IBR) is the most common technique for breast reconstruction. The use of ADMs, the increased tendency for prepectoral reconstructions, and the rise of nipple-sparing mastectomies have enhanced the aesthetic demand of breast reconstruction. In this setting, the primary resource for correcting deformities once patients have achieved an adequate volume with two-stage IBR, is autologous fat grafting. Here, we compared the surgical and oncologic outcomes of Simultaneous Fat Grafting During TE-to-Implant Exchange (SFG-TtIE) versus a no fat grafting during exchange.
Methods: A retrospective review was performed of all consecutive patients undergoing two-stage implant-based breast reconstruction with TE from 01/2011-12/2020. Hybrid reconstructions with autologous tissue during TE insertion or TE-to-implant exchange were excluded. Propensity score matching was implemented by incorporating several demographics, clinical, oncologic, and surgical variables to optimize comparability between group. The control group did not receive fat grafting at the time of TE-to-implant exchange.
Results: Initially, 183 (38.6%) reconstructions underwent SFG-TtIE, while 291 (61.39%) reconstructions were assigned to the control group. After propensity score matching, 196 reconstructions were evaluated, each group with 98 cases. Reconstructions in the SFG-TtIE received larger implants during exchange in comparison to the control group (539±135.1-cc versus 495.97±148-cc, p=0.035). The mean volume of fat lipoinjected during TE-to-Implant exchange in the SFG-TtIE group was 88.79±41-ml. A higher proportion of reconstructions in the SFG-TtIE group underwent additional fat grafting after exchange versus the control group (19% versus 9%, p=0.041). Before propensity score matching, higher rates of fat necrosis (9.3% versus 1.4%, p<.001) and wound-related complications (4.9% versus 1.7%, p=0.045) were found in the SFG-TtIE group in comparison to the standard exchange group. After matching, reconstruction from the SFG-TtIE group and the control group had comparable rates for almost all complications. Nonetheless, the rate of fat necrosis after exchange remained significantly higher in the SFG-TtIE group (10% versus 2%, p=0.017). The rate of breast cancer recurrence (3% versus 5%, p=1.00) and breast cancer mortality (0% versus 3%, p=0.496) was comparable between the SFG-TtIE group and control group. The mean follow-up was not significantly different between groups (35.84±15.41 months versus 40.22±27.96 months, p=0.676).Conclusion: SFG-TtIE is a safe procedure to improve the conus and envelope of the reconstructed breast during two-stage IBR. SFG-TtIE does not increase the rate of periprosthetic infection or wound-related complications versus no fat grafting during TE-to-Implant exchange. Additionally, it did not increase the rate of breast cancer recurrence at an average 3-year follow-up.
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