Review of Autologous Fat Grafting in Postmastectomy Reconstruction Patients: Nonroutine Diagnostics and Oncologic Safety

Radiologic findings in women after Autologous Fat Transfer (AFT) based breast reconstruction: A Systematic Review

Purpose

Autologous fat transfer (AFT) is increasingly used in breast reconstructive surgery. Due to post-surgical changes, in breast imaging after AFT, it can be challenging to differentiate between benign and suspicious findings. This systematic review aimed to present an overview of the literature on breast imaging after AFT-based breast reconstruction. The descriptive radiologic findings focus on different breast imaging modalities (i.e., mammography (MG), ultrasound (US), and breast magnetic resonance imaging (MRI)) to provide an overview of the most commonly reported benign and suspicious findings.

Results

The literature search yielded 20 studies from 2006-2022 that reported AFT-based breast reconstructions and included the radiologic evaluation of the included breast imaging modalities. Only six of the 20 included studies provided qualitative descriptions of radiologic findings. Fat necrosis was most frequently reported. On MG, fat necrosis was described in a variety of stages such as oil cyst or cytosteatonecrosis with or without calcifications. On US, it was described as a nonvascular hypo- or anechoic mass, and on breast MRI, it was most frequently reported as hypointense homogenous architectural distortion. Additional biopsies to differentiate between benign and malignant findings after AFT-based breast reconstruction were reported in 13 of the 20 studies. Among all included studies in the current review, a total of 34 of 137 biopsies were considered malignant (24.8%).

Conclusion

Qualitative descriptions of the reported radiologic findings after AFT for breast reconstruction were limited. Additional biopsies can be considered to differentiate between benign and suspicious findings. More experience and research are necessary to improve the interpretation of breast imaging after AFT-based breast reconstructions.

Fat grafting in breast surgery: a retrospective single-breast centre 6-year experience

PURPOSE

In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting.

METHODS

In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain.

RESULTS

No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively).

CONCLUSIONS

Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers.

Autogenous breast reconstruction for total mastectomies: a narrative review

Background and Objective

Mastectomies have a significant socio-psychological impact, motivating patients to undergo breast reconstruction. Initially, silicone implants were used to reconstruct the breast. However, breast implants have been the subject of successive crises throughout the years. Indeed, rupture, silicone bleeding, and capsular contracture remain topical. In 2019, the BIOCELL textured breast implants was banned and recalled due to the discovery of the breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). More recently, the breast implant illness has been depicted in the media. To cope with these issues and to respond to some patients' expectations for a natural reconstruction, plastic surgeons have developed autogenous solutions for breast reconstruction. Since Taylor's research on angiosomes, the development of the microsurgery and more recently fat grafting, autogenous breast reconstruction has known a tremendous expansion. Autologous breast reconstruction allows a more natural feeling and texture. This narrative review aims to provide to the readers a comprehensive and updated evidence-based overview of state of the art about autologous breast reconstruction after total mastectomy.

Methods

We conducted a narrative review of the literature searching for papers published between January 2010 and December 2022. The MeSH terms with different combinations were used to identify articles for inclusion. After screening article titles and abstracts independently by three authors, 66 papers were included in this review.

Key Content and Findings

In this review, the authors describe and discuss the different autogenous techniques in breast reconstruction.

Conclusions

Autologous reconstructions provide very satisfactory, durable, and reliable results with relatively low complication rates. Deep inferior epigastric perforator (DIEP) flaps, latissimus dorsi flaps and autologous fat grafting are the most common type of autogenous breast reconstructions.