The Serial Free Fat Transfer in Irradiated Prosthetic Breast Reconstructions

This study investigated the effects of lipofilling on both the functional and the aesthetic aspects of breast reconstruction. Sixty-one consecutive patients with irradiated reconstructed breasts (62 breasts) were offered free fat transfer to enhance the results and correct the defects. Twenty patients were enrolled (active branch) and underwent multiple sessions of lipofilling, while the others were considered controls. The fat was harvested by syringe and processed by saline washing only (no centrifugation). Three months after the last session the functional outcome was evaluated using the LENT-SOMA scoring system and the aesthetic outcome was evaluated using a visual 5-point scale. A significant improvement in all the LENT-SOMA scores after free fat grafting was observed; the scores after treatment were all significantly lower than those before it and were also significantly lower than those of untreated breasts. These results also were confirmed by comparing homogeneous subgroups of breasts with similar LENT-SOMA ranks before treatment. Similarly, the cosmetic outcomes were significantly enhanced after serial lipofilling. The four cases in the active branch with severe flap thinning resolved with no implant exposure (mean follow-up = 17.6 months), while implant exposure occurred in the two cases with the same problem in the control group. In one case, a Baker 3-4 capsular contracture was downgraded to Baker 1 after only one session of lipofilling. No complications occurred in the treated cases. Free fat transfer is a safe and reliable technique in improving the outcomes of irradiated reconstructed breasts with implants.