Effects Of Volume And Radiotherapy On Outcomes In Patients Undergoing Autologous Fat Grafting For Breast Reconstruction
Joshua A. David, MD, Lily Camison, MD, Walter J. Joseph, MD, Sydney R. Coleman, MD, Carolyn De La Cruz, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
PURPOSE: Autologous fat grafting (AFG) is increasingly utilized in breast reconstruction, yet is often compromised by radiation therapy. Few studies have evaluated the effects of injected fat volume and patient radiation status on outcomes in breast reconstruction.
METHODS: A systematic literature review was conducted according to PRISMA guidelines to identify studies reporting radiotherapy status, lipo-injection volumes, and outcomes for patients undergoing AFG-assisted breast reconstruction, and compared between breasts that were radiation-naive (non-irradiated), and those that received radiation prior to AFG (pre-irradiated) and after AFG (post-irradiated).
RESULTS: We identified 1,341 articles. 12 were included in the final analysis, comprising 115 breasts total. Injection volume, number of sessions, and duration of treatment were similar in non-irradiated and pre-irradiated breasts, but significantly decreased in post-irradiated breasts. Despite this, short-term complications were increased 10-fold in post-irradiated breasts. ROC analysis demonstrated this risk occurs with only 68mL of fat, and increases 4-fold with volumes above 128mL. Long-term radiologic complications and graft-take were similar across the three groups.
CONCLUSION: Our results suggest that AFG should be approached with caution or delayed in patients who will receive future radiotherapy, particularly when expecting larger volume requirements. In breasts that have previously undergone radiation therapy, increased fat volumes do not affect short or long-term outcomes compared to radiation-na´ve breasts, making it a safe option for breast reconstruction in these patients.
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