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Purpose
Autologous breast reconstruction offers higher overall rates of patient satisfaction, but unfortunately not all patients are ideal candidates due to inadequate volume of donor sites. While, autologous fat grafting is frequently used to augment volume and contour abnormalities in implant-based breast reconstruction clear utility in microsurgical breast reconstruction has not been described. Here, we examined the utility and indications for fat grafting in patients who underwent autologous microsurgical breast reconstruction.
Methods
A retrospective review of all patients undergoing autologous breast reconstruction with microvascular free flaps at New York University Langone Medical Center between November 2007 and October 2010 was conducted. Patients were divided into two groups: those requiring postoperative fat grafting and those not requiring fat grafting. Patient demographics, indications for surgery, history of radiation therapy, patient BMI, mastectomy specimen weight, need for rib resection, area of flap weight, and complications were analyzed in comparison.
Results
In the three year study period, 141 patients underwent 228 microvascular free flaps for breast reconstruction. Fifty eight (25.4%) reconstructed breasts underwent postoperative fat grafting, with an average of 1.12 operative sessions. Fat was most commonly injected in the medial and superior medial poles of the breast and the average volume injected was 170mL per breast (22-564mL). The average ratio of fat injected to initial flap weight was 0.59 (0.07-1.39). Patients undergoing fat grafting were more likely to have had rib resection for exposure to IMA/IMV (56% vs 41% p< 0.05), acute postoperative complications requiring operative intervention (25.8% vs 14.1% p <0.05), preoperative radiation therapy, (18.9% vs 5.9% p <0.05) and DIEP flap reconstructions as compared to muscle sparing TRAM flaps (75.8% vs 53. 2% p <0.05). Preoperative breast size, BMI, and flap size were not found to be significantly different in patients undergoing fat grafting.
Conclusion
Use of fat grafting in concert with microsurgical breast reconstruction is most commonly used in patients requiring rib harvest, DIEP flap reconstructions, and those with acute postoperative complications. Notably, use was not restricted to patients with lower BMI or smaller breasts. Therefore, fat grafting should be considered a powerful adjunct to optimize contour in volume-adequate breast reconstructions, as well as a means to augment size in volume-deficient reconstructions.