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Strong AL, Syrjamaki JD, Kamdar N, Wilkins EG, Sears ED. Oncological Safety of Autologous Fat Grafting for Breast Reconstruction. Ann Plast Surg 2024; 92:21-27. [PMID: 38117044 PMCID: PMC10752252 DOI: 10.1097/sap.0000000000003772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Autologous fat grafting has become a vital component of breast reconstruction. However, concerns remain regarding the safety of fat grafting after oncological resection and breast reconstruction. The purpose of the study was to evaluate the association of fat grafting after breast reconstruction with metastasis and death in breast cancer patients. METHODS A retrospective, population-based cohort study was conducted using deidentified claims data from 2001 to 2018 and included privately insured patients with breast cancer who underwent breast reconstruction after surgical resection. Breast reconstruction patients who underwent fat grafting were compared with those not undergoing fat grafting, evaluating metastasis and death up to 15 years after reconstruction. One-to-one propensity score matching was used to account for selection bias on patient risk factors comparing those with and without fat grafting. RESULTS A total of 4709 patients were identified who underwent breast reconstruction after lumpectomy or mastectomy, of which 368 subsequently underwent fat grafting. In the propensity score-matched patients, fat grafting was not associated with an increased risk of lymph node metastasis (9.7% fat-grafted vs 11.4% in non-fat-grafted, P = 0.47) or distant metastasis (9.1% fat-grafted vs 10.5% in non-fat-grafted, P = 0.53). There was no increased risk of all-cause mortality after fat grafting for breast reconstruction (3.9% fat-grafted vs 6.6% non-fat-grafted, P = 0.10). CONCLUSIONS Among breast cancer patients who subsequently underwent fat grafting, compared with no fat grafting, no significant increase was observed in distant metastasis or all-cause mortality. These findings suggest that autologous fat grafting after oncologic resection and reconstruction was not associated with an increased risk of future metastasis or death.
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Affiliation(s)
- Amy L. Strong
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, 48109
| | - John D. Syrjamaki
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, 48109
| | - Neil Kamdar
- Michigan Value Collaborative, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, 48109
| | - Edwin G. Wilkins
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, 48109
| | - Erika D. Sears
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Rijkx MEP, Heuts EM, Houwers JB, Hommes JE, Piatkowski AA, van Nijnatten TJA. Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know. BJR Open 2024; 6:tzae010. [PMID: 38798692 PMCID: PMC11128096 DOI: 10.1093/bjro/tzae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/09/2024] [Accepted: 04/13/2024] [Indexed: 05/29/2024] Open
Abstract
Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited. The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy. Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence). In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.
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Affiliation(s)
- Maud E P Rijkx
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Janneke B Houwers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
| | - Juliette E Hommes
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Andrzej A Piatkowski
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- GROW Research Institute for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
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Breast Autologous Fat Transfer Entirely Under Tumescent Anesthesia: Safety and Efficacy. Dermatol Surg 2022; 48:1324-1327. [PMID: 36449875 PMCID: PMC9719836 DOI: 10.1097/dss.0000000000003609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND/OBJECTIVES The prior use of external expansion has been described in the literature as a tool to allow reliable grafting of more than 200 mLs of autologous fat under general anesthesia. The purpose of this study was to determine whether breast autologous fat transfer entirely under tumescent anesthesia (BAFTEUTA) is a safe and effective technique. METHODS After institutional board approval, 22 consecutive patients were enrolled in this single-cohort, prospective study. All patients underwent preoperative expansion using manually evacuated domes. All procedures were performed under tumescent anesthesia with oral sedation. RESULTS There was a median successful graft of 200 mLs. Complications were minimal and limited to occlusive folliculitis. CONCLUSION Although the author has not reported as large graft volumes as some other authors, BAFTEUTA is a safe procedure and can have good outcomes with high levels of patient satisfaction.
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Liao X, Wang X, Xu Z, Guo S, Gu C, Jin Z, Su T, Chen Y, Xue H, Yang M. Assessment of facial autologous fat grafts using Dixon magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:2830-2840. [PMID: 35502384 PMCID: PMC9014153 DOI: 10.21037/qims-21-570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/24/2022] [Indexed: 09/07/2023]
Abstract
BACKGROUND Autologous fat grafting is a procedure that treats soft tissue defects by reallocating fat to improve a patient's physical appearance. Imaging methods may be used to evaluate and monitor the grafted fat after transplantation. The goal of imaging is to examine the signal and volume of the grafted fat after autologous fat grafting during the adipose tissue recovery. However, researchers have yet to examine the feasibility of using fat-only imaging to assess the autologous fat graft. METHODS In this prospective and observational study, 46 injected sides in 23 female patients (age 35±7.8 years) were included in the image evaluation. The patients underwent autologous fat grafting surgery with filtered and washed fat. A total of 16, 18, and 12 sides were scanned 7 days, 3 months, and 1 year after fat grafting, respectively. Fat-only images were obtained using Dixon imaging, and then the image quality and contrast of the T1W and T2W were rated to evaluate the application of this method when imaging the autologous fat. The signal and volume of the autologous fat graft were recorded to assess the retention during recovery of the autologous fat tissue. RESULTS Fat-only T1W magnetic resonance imaging (MRI) was used to identify and delineate grafted fat because this method had better image quality and image differentiation than did T2W MRI. The average signal contrast and retention rate measured 7 days postoperation (28.8%±4.7%; 94.1%±5.8%) was the highest and then decreased at 3 months (16.3%±2.1%; 48.7%±17.3%) and 1 year (3.3%±1.3%, 33.1%±12.9%) after surgery. There were statistically significant differences between the signal and volume retention measurements at each postoperative recovery phase. CONCLUSIONS The T1W fat-only images produced by Dixon MRI is a feasible approach for identifying grafted fat and measure postoperative changes during clinical evaluation. We found a significant decrease in signal contrast and volume of the grafted fat from the surgery date to 3 months postoperation and from 3 months to 1-year postoperation.
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Affiliation(s)
- Xueyin Liao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqi Wang
- Philips Healthcare, the World Profit Centre, Beijing, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiwei Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congmin Gu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyong Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Roy PG, Yan Z, Nigam S, Maheshwari K. Aesthetic breast surgery: putting in context-a narrative review. Gland Surg 2021; 10:2832-2846. [PMID: 34733731 DOI: 10.21037/gs-20-892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/12/2021] [Indexed: 01/13/2023]
Abstract
Objective This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage. Background Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction. Methods Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines. Conclusions Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
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Affiliation(s)
- Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Zhiyan Yan
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Shashank Nigam
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Kavish Maheshwari
- Department of Plastic Surgery, Bedfordshire Hospitals NHS Trust, Bedfordshire, UK
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