Chest wall irradiation is becoming increasingly common for mastectomy patients who have opted for immediate breast reconstruction with tissue expanders and implants. The optimal approach for such patients has not yet been defined. This study assesses the outcomes of a reconstruction protocol for patients who require irradiation after tissue expander/implant reconstruction. The charts of all patients who underwent immediate tissue expander/implant reconstruction at Memorial Sloan-Kettering Cancer Center between January of 1995 and June of 2001 and who had not previously undergone irradiation were retrospectively reviewed. A subgroup of patients who required chest wall irradiation after mastectomy and reconstruction was identified. Those patients were treated according to the following treatment algorithm: (1) reconstruction with tissue expander placement at the time of mastectomy , (2) tissue expansion during postoperative chemotherapy, (3) exchange of the tissue expander for a permanent implant approximately 4 weeks after the completion of chemotherapy, and (4) chest wall irradiation beginning 4 weeks after the exchange. All irradiated patients with at least 1 year of follow-up monitoring after the completion of radiotherapy were evaluated with respect to aesthetic outcomes, capsular contracture, and patient satisfaction. A control group of nonirradiated patients was randomly selected from the cohort of patients treated during the study period. During the 5-year study period, a total of 687 patients underwent immediate reconstruction with tissue expanders. Eighty-one patients underwent postoperative irradiation after placement of the final implant. A total of 68 patients who received postoperative chest wall irradiation underwent at least 1 year of follow-up monitoring after the completion of radiotherapy, with a mean follow-up period of 34 months. Seventy-five nonirradiated patients were evaluated as a control group. Overall, 68 percent of the irradiated patients developed capsular contracture, compared with 40 percent in the nonirradiated group (p = 0.025). Eighty percent of the irradiated patients demonstrated acceptable (good to excellent) aesthetic results, compared with 88 percent in the nonirradiated group (p = not significant). Sixty-seven percent of the irradiated patients were satisfied with their reconstructions, compared with 88 percent of the nonirradiated patients (p = 0.004). Seventy-two percent of the irradiated patients stated that they would choose the same form of reconstruction again, compared with 85 percent of the nonirradiated patients. The results of this study suggest that tissue expander/implant reconstruction is an acceptable surgical option even when followed by postoperative radiotherapy and should be considered in the reconstruction algorithm for all patients, particularly those who may not be candidates for autogenous reconstruction.

Irradiation after immediate tissue expander/implant breast reconstruction: Outcomes, complications, aesthetic results, and satisfaction among 156 patients

Importance Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed US Food and Drug Administration regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. Objective To determine whether fat grafting is associated with patient-reported outcomes (PROs) in patients undergoing breast reconstruction. Design, Setting, and Participants A longitudinal, multicenter, prospective cohort study was conducted between February 1, 2012, and July 31, 2016, at the 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women 18 years or older presenting for breast reconstruction after mastectomy with 2 years or more of follow-up. All primary procedure types (implant based and flap based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by 1 year after starting reconstruction. Interventions Fat grafting as an adjunct to breast mound reconstruction. Main Outcomes and Measures Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q survey, with higher scores on a 0- to 100-point scale indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between those who received and did not receive fat grafting. Results A total of 2048 women were included (mean [SD] age, 49.4 [10] years), with 165 (8.1%) undergoing fat grafting between years 1 and 2. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference [AMD], −4.74; 95% CI, −8.21 to −1.28; P  = .008), psychosocial well-being (AMD, −3.87; 95% CI, −7.33 to −0.40; P  = .03), and sexual well-being (AMD, −5.59; 95% CI, −9.70 to −1.47; P  = .008), compared with those who did not receive subsequent fat grafting. Following the procedure, the fat-grafted cohort reported similar breast satisfaction (AMD, −0.68; 95% CI, −4.42 to 3.06; P  = .72), psychosocial well-being (AMD, −0.59; 95% CI, −3.92 to 2.74; P  = .73), and sexual well-being (AMD, −2.94; 95% CI, −7.01 to 1.12; P  = .15) 2 years postoperatively. Conclusions and Relevance Fat grafting may improve breast satisfaction, psychosocial well-being, and sexual well-being in patients undergoing breast reconstruction.

/pdf/association-of-fat-grafting-with-patient-reported-outcomes-1vo3xmg0so.pdf

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Summary Introduction Breast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients’ satisfaction. Methods Women who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction. Results A total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction. Conclusion The authors identified factors of higher patients’ satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities.

Multicenter evaluation of quality of life and patient satisfaction after breast reconstruction, a long-term retrospective study.

Background: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject. Methods: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q. Results: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien–Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort. Conclusions: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.

/pdf/breast-reconstruction-by-exclusive-lipofilling-after-total-2639w1lg.pdf

Breast Reconstruction by Exclusive Lipofilling after Total Mastectomy for Breast Cancer: Description of the Technique and Evaluation of Quality of Life

Background Breast cancer is the most frequent form of cancer among women worldwide. Reconstructive surgery may improve the quality of life (QoL), after mastectomy. Various techniques are used to reconstruct the female breast; however, few is known about its specific post-surgery influence represented in patient-reported outcomes. Objective This systematic review assesses the difference in patient-reported QoL between prosthetic reconstruction alone, and prosthetic reconstruction with additional autologous fat transfer (AFT). Data sources A literature search was performed in PubMed, Embase, Cochrane and CINAHL online databases from inception to February 11th, 2020. Study selection Inclusion and exclusion criteria were used to assess the eligibility of the retrieved articles. The only eligible studies were cohort studies. Data collection and analysis Relevant data for the research question was extracted from the articles and systematically documented. Results not contributing to answering the objective were intentionally left out. No meta-analysis was realized. Results This systematic review resulted in the inclusion of only six relevant studies, all cohort studies, consisting of 1437 unique patients. These studies evaluated the quality of life of patients by means of the validated BREAST-Q questionnaire. Outcomes varied for which reason no definite answer could be provided to whether additional AFT results in a higher QoL. Conclusions It is unclear whether additional AFT after prosthetic surgery leads to a higher QoL when compared to sole prosthetic reconstruction or not. Additional studies, assessing the QoL of patients who received additional AFT, are required to draw solid conclusions. Level of evidence Level III; systematic literature review of cohort studies.

Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: A systematic review.

Resume But de l’etude Evaluer les resultats cliniques esthetiques, la satisfaction et la qualite de vie relative a la sante chez les patientes ayant beneficie d’une reconstruction mammaire par lipofilling exclusif ou en complement d’autres techniques chirurgicales. Materiels et methodes Une etude retrospective observationnelle a ete menee entre 2009 et 2014 chez quatre groupes de patientes ayant beneficie d’un lipofilling par un meme operateur, soit en complement d’un traitement conservateur (groupe 1), soit de maniere exclusive (groupe 2), soit en complement d’un lambeau (groupe 3) ou de protheses (groupe 4). Les donnees sociodemographiques, liees au lipomodelage ou a la pathologie tumorale ont ete recueillies et reportees dans un logiciel concu pour cette etude. La satisfaction et la qualite de vie apres lipomodelage a ete evaluee a l’aide du questionnaire BREAST Q © module reconstruction mammaire postoperatoire. Resultats Cent soixante-dix procedures de lipomodelage ont ete realisees chez 68 patientes. Le volume moyen transfere etait de 1421,2 cm 3  pour le groupe lipomodelage exclusif et le nombre de seances moyen etait de 4,9 etale sur une duree de 15,6 mois en moyenne. En adjuvant d’une technique ou d’une chirurgie conservatrice, le volume moyen total transfere etait de 212,2 cm 3  et le nombre de seances moyen etait de 1,4. L’abdomen etait le site donneur le plus utilise et la face posterieure des cuisses exclusivement utilisee en reconstruction exclusive. Le taux de cytosteatonecroses etait de 8,8 % ( n  = 6). Un seul cas d’infection a ete note. La recidive tumorale a dix mois apres lipomodelage a concerne deux patientes. Le taux de reponse etait de 80,8 %. Le lipomodelage ameliore le resultat cosmetique final avec un taux de 91,1 % de patientes satisfaites ou tres satisfaites vis-a-vis de leur sein. Au total, 95,4 % des patientes du groupe lipomodelage exclusif ont trouve un benefice secondaire apres intervention. La qualite de vie apres lipomodelage est egalement amelioree sur le plan social et sexuel dans les quatre groupes avec un meilleur resultat chez les patientes ayant beneficie d’un traitement conservateur. Conclusion Le lipomodelage est une technique simple, fiable, necessitant une courbe d’apprentissage, permettant d’ameliorer le resultat esthetique final et la qualite de vie qu’il soit utilise de maniere exclusive ou en complement d’autres techniques.

Fat grafting in breast reconstruction. Retrospective study of satisfaction and quality of life about 68 patients

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Fat grafting in breast reconstruction. Retrospective study of satisfaction and quality of life about 68 patients