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Fat-graft Protocol For Total Autologous Reconstruction Following Nipple-sparing Mastectomy In Irradiated And Non-irradiated Breasts
Fabio Santanelli di Pompeo, MD, PhD1, Benedetto Longo, MD, PhD2, Rosaria Laporta, MD, PhD2.
1sapienza University, Rome, Italy, 2Sapienza University, Rome, Italy.

Introduction
Rate of fat-grafting take may depend on several issues including irradiated recipient beds. Its use in reconstruction of previously irradiated nipple-sparing mastectomy (NSM) needs further clarification.
Methods
Between 2008-2014, 42 NSMs, mean weight 358g (range 220-470g) (29 patients), were prospectively enrolled in fat grafting reconstruction, and stratified in Group-A (28 non-irradiated) and Group-B (14 irradiated). Fat-tissue was dry-harvested with 2/3 mm cannula and 10-ml syringe, centrifuged at 3000 r.p.m./3-minute and injected with a blunt cannula and 1-ml syringe in subcutaneous and submuscular layers. The injected fat volume for each session was equal to 1/3 of the mastectomy weight. The rule of 30% more was applied from the second to the last session for the incomplete graft-taking. Variables were analyzed using the student t-test and Kruskal-Wallis test considering p≤0.05 as significant.
Results
The two groups were homogeneous regarding demographics (p>0.05), while number of sessions, mean volume of first two treatments and overall injected showed significant difference (p=0.003; p=0.004; p=0.005). Volume, shape, breast mound position, inframammary-fold, scar location subscales and global score had high evaluation in both groups (p>0.05), while skin-texture and total subscales scored less in Group-B than in Group-A (p=0.006; p=0.003).
Conclusion
The first prospective fat-transfer reconstruction series, with systematic approach, showed overall pleasing aesthetic outcomes but needs more fat-transfer sessions in irradiated NSMs.


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