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Fat graft survival in the radiated breast compared to non-radiated breast: Volume measurement using 3D imaging
Kevin H. Small, MD, Nolan Karp, MD, Chaya Levovitz, BS, Christina Lee, BA, Mihye Choi, MD.
New York University, New York, NY, USA.
Radiation therapy for breast cancer alters underlying tissue perfusion and oxygenation, which can result in skin discoloration, subcutaneous tissue fibrosis and associated capsular contracture of the reconstructed breast. Management of these contour deformities remains a challenge, but fat grafting (FG) has emerged as a possible tool for correcting volume, symmetry, and overall shape in the radiated breast. Various advancements have been made in the techniques of fat graft harvest and delivery, but our ability to judge the incorporation of fat grafting to radiated tissue remains limited. The following study applies 3D imaging technology to assess the stability of breast shape following autologous fat transfer to the radiated reconstructed breast.
All patients receiving fat grafting to the reconstructed breast from 2009-2010 were enrolled in the study. The average time interval between radiation and autologous fat transfer was greater than six months. FG surgery was performed using a modified Coleman technique to achieve symmetry. Preoperative and post-operative 3D scans were obtained on all patients. 3D imaging was performed using the Canfield VECTRA system and analyzed using Geomagic software. As previously described, breasts were isolated as closed objects and total breast volume was calculated on every scan.
In the observed time period, fifty-nine non-radiated patients (eighty-eight breasts) and twenty-six radiated patients (twenty-eight breasts) received autologous fat transfer and associated three-dimensional images. Average fat injected to the breast was 91cc to the non-radiated breast and 110cc to the radiated breast. For the non-radiated breast, one month post-operatively, the breast had 70 percent volume retention and resorption rate of 1cc/day, and two months post-operatively, the breast had 59 percent volume retention and resorption rate of 0.9cc/day. The radiated patients are subdivided into 9 lumpectomy patients, 11 autologous reconstruction patients, and 8 implant reconstruction patients; there is no statistical significance between the subsets. For the radiated breast, one month post-operatively, the breast had 69 percent volume retention and resorption rate of 1.4cc/day, and two months post-operatively, the breast had 58 percent volume retention and resorption rate of 0.8cc/day. The non radiated patients are subdivided into 5 lumpectomy patients, 29 autologous reconstruction patients and 54 implant reconstruction patients; there is no statistical significance between the subsets.
Fat grafting (FG) is a useful method for breast contouring in the reconstructed radiated patient. Our data suggests that radiation therapy does not affect percent volume retention and resorption rate. Long-term studies are needed to assess the stability of the radiated breast after autologous fat transfer.
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