Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal

• Published in: European journal of plastic surgery Vol. 40; no. 5; pp. 447 - 454
• Main Authors: Debald, Manuel, Pech, Thomas, Kaiser, Christina, Keyver-Paik, Mignon-Denise, Walgenbach-Bruenagel, Gisela, Kalff, Joerg C., Kuhn, Walther, Walgenbach, Klaus J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2017
• Subjects: Medicine; Medicine & Public Health; Original Paper; Plastic Surgery; Fat transfer; Breast cancer; Regenerative medicine; Breast reconstruction; Lipofilling; Radiation
• ISSN: 0930-343X; 1435-0130
• DOI: 10.1007/s00238-017-1311-1

Background
Lipofilling or autologous fat transfer is an established technique in plastic surgery. Herein, we describe the lipofilling effects after implant-based breast reconstruction in post-radiation patients and propose an algorithm for indication of lipofilling.
Methods
Forty patients with a history of breast cancer were included in this retrospective analysis. Patients had undergone either breast conserving therapy or mastectomy. Twenty-six patients underwent additional radiation therapy. Patients were assessed using a post-radiation skin scoring classification.
Results
In total, 68 lipofilling procedures were analyzed. Scar release, skin softening, improved quality of life, and improvement of post-radiation findings are results of lipofilling with a closed filtration system. In all patients with post-surgical radiation, an improvement of tissue quality was observed. Staging revealed that lipofilling improved mean post-radiation skin scores of 2.40 ± 0.89 to 1.21 ± 0.76 (
p
 ≤ 0.000). There was no recurrence of breast cancer in our study patients.
Conclusions
This study introduces an algorithm using lipofilling in reconstructive breast surgery and especially in post-radiation patients with low risks as well as very high acceptance in patients with various indications for this procedure. A regenerative aspect was also detectable in patients following radiation therapy and reconstruction. Lipofilling is a safe and effective procedure with a low incidence of minor complications. It is therefore a feasible method to resolve volume deficiencies and asymmetric results after oncologic breast surgery. Nevertheless, a prospective study has now been initiated focusing on the oncologic safety of lipofilling including ultrasound and radiological examinations to validate the findings of this initial study.
Level of Evidence: Level IV, therapeutic study.