by Cason, Roger W.; Shammas, Ronnie L.; Broadwater, Gloria;
Glener, Adam D.; Sergesketter, Amanda R.; Vernon, Rebecca; Le, Elliot;
Wickenheisser, Victoria A.; Marks, Caitlin E.; Orr, Jonah; Pyfer, Bryan J.;
Hollenbeck, Scott T.
Plastic and
Reconstructive Surgery: December 2020
- Volume 146 - Issue 6 - p 1227-1236
Background:
Fat grafting to the reconstructed breast may result in the
development of benign lesions on physical examination, prompting further
investigation with imaging and biopsy. The aim of this study was to assess the
influence of fat grafting on the incidence of imaging and biopsies after
postmastectomy reconstruction.
Methods:
Patients who underwent autologous or implant-based
reconstruction following mastectomy from 2010 to 2018 were identified. Those
receiving fat grafting as part of their reconstructive course were propensity
matched 1:1 to those that did not with body mass index, reconstruction timing,
and reconstruction type as covariates in a multivariable logistic regression
model.
Results:
A total of 186 patients were identified, yielding 93
propensity-matched pairs. Fat-grafted patients had higher incidences of
palpable masses (38.0 percent versus 18.3 percent; p = 0.003) and
postreconstruction imaging (47.3 percent versus 29.0 percent; p = 0.01), but no
significant difference in the number of biopsies performed (11.8 percent versus
7.5 percent; p = 0.32). Imaging was predominately interpreted as normal (Breast
Imaging-Reporting and Data System 1, 27.9 percent) or benign (Breast
Imaging-Reporting and Data System 2, 48.8 percent), with fat necrosis being the
most common finding [n = 20 (45.5 percent)]. No demographic, oncologic,
reconstructive, or fat grafting–specific variables were predictive of receiving
postreconstruction imaging on multivariate analysis. Fat grafting was not
associated with decreased 5-year overall survival or locoregional
recurrence-free survival.
Conclusions:
Fat grafting to the reconstructed breast is associated with
increased incidences of palpable masses and subsequent postreconstruction
imaging with benign radiographic findings. Although the procedure is
oncologically safe, both patients and providers should be aware that concerning
physical examination findings can be benign sequelae of fat grafting and may
lead to increased imaging after breast reconstruction. Clinical Question/Level
of Evidence: Therapeutic, III.
