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Effects of Volume and Radiotherapy on Outcomes in Patients Undergoing Autologous Fat Grafting for Breast Reconstruction
Joshua David, MD, Pooja Humar, BS, Casey Zhang, BS, Sydney Coleman, MD, Carolyn De La Cruz, MD
University of Pittsburgh Medical Center
2022-02-01
Presenter: Pooja Humar
Affidavit:
All of the work on this project represents the original work of the residents and students involved.
Director Name: Dr. Carolyn De La Cruz
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Autologous fat grafting (AFG) is increasingly utilized in breast reconstruction. It is well-established that radiation can compromise results, but few studies have evaluated the effects of injection volume and radiation timing on outcomes in breast reconstruction.
Methods: A systematic review was conducted to identify studies that specifically reported radiotherapy status and lipo-injection volume. We identified 1,533 articles, 12 of which were included in the final analysis.
Results: 115 breasts met inclusion criteria, and were categorized as follows: 51 (44.3%) non-irradiated, 44 (38.3%) radiated prior to AFG (pre-irradiated), and 20 radiated after AFG (post-irradiated). Groups were similar in patient age, BMI, and duration from initial operation to first AFG session. Although fat injection volume, number of grafting sessions, and duration of treatment were significantly decreased in post-irradiated breasts (p<0.001), this group experienced a 10-fold rate of short-term complications as compared to both pre- and non-irradiated breasts (25% vs 2.27% vs. 9.98%, respectively). Furthermore, ROC curve analysis detected this risk once graft volumes exceeded 68mL, with a further increasing 4-fold increase above 128mL (p=0.04, 95% CI 0.62-1.0). Long-term complications and graft survival were similar across the 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, the short and long-term outcomes effects of increasing graft volume are similar to those of radiation-naïve breasts, making it a safe option for breast reconstruction in these patients.
