by Lesniak, David M.; Sarfati, Isabelle; Meredith, Ineke;
Millochau, Jenny; Wang, Kuan-Chi; Nos, Claude; Clough, Krishna B.
Plastic and Reconstructive Surgery: January 2022
- Volume 149 - Issue 1 - p 52-56
The majority of patients undergoing bilateral prophylactic
mastectomy request immediate implant-based breast reconstruction. Some
patients, especially those with prior radiotherapy, are at increased risk of
early cutaneous complications and implant loss. The authors developed the
technique of primary fat grafting before delayed prophylactic mastectomy to
minimize early complications for selective high-risk patients. They have completed
21 cases in 14 patients, 10 of whom had previous lumpectomy and radiation
treatment for breast cancer. A single session of fat grafting, with a median
injection volume of 250 ml (interquartile range, 200 to 300 ml), was performed
a median period of 19 weeks (interquartile range, 16 to 28 weeks) before
prophylactic mastectomy. All cases were direct-to-implant reconstruction using
textured silicone implants. The median implant volume was 410 ml (interquartile
range, 318 to 450 ml). A minor early complication developed in 14 percent of
cases (three of 21), with no early implant loss. At a median follow-up of 9
months (interquartile range, 5 to 27 months), the authors found no cases of
implant loss and an excellent or good aesthetic outcome (score of 5 or 4) in 16
of 21 cases (76 percent). Fat grafting before prophylactic mastectomy is a
novel strategy to minimize early complications and avoid implant loss in
patients at high risk of postoperative complications. CLINICAL QUESTION/LEVEL
OF EVIDENCE: Therapeutic,
