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OBJECTIVE: Radiation is detrimental to breast reconstruction and increases the risk of complications, especially after implant placement. Thus, autologous tissue transfer is preferred for breast reconstruction following radiation. Frequently, radiation-induced fibrosis of the breast and chest wall precludes expansion of the remaining skin envelope mandating the use of distant tissues. It is crucial to salvage as much of the native breast skin as possible to conceal any unmatching tissue. Fat grafting has been shown to improve the quality of radiation-damaged tissues favoring their biological and mechanical restoration. We present a novel surgical approach utilizing autologous fat grafting to revitalize the radiated mastectomy skin prior to microsurgical breast reconstruction. METHODS: A retrospective case series including nine patients who received nipple-sparing mastectomy or skin-sparing mastectomy followed by radiotherapy. Fat grafting was transferred 7-27 months after radiation treatment, 4-12 months before reconstructive surgery. Patient demographics, surgical and radiation therapy dates, surgical details, and complications were collected. RESULTS: All patients tolerated fat grafting. At follow up, a small seroma at the site of fat grafting and scar release was found in each patient. The seromas were aspirated and resolved. The treated skin remained viable. The fat grafted tissues were detached from the chest wall and considerably more pliable. All patients reported reduced pain on the fat grafted site. Free flap breast reconstructive procedures were uneventful. During free tissue transfer, the entire available mastectomy skin and nipples were salvaged. CONCLUSION: Reinvigorating radiated tissues with fat grafting prior to autologous tissue transfer can salvage the mastectomy skin and yield aesthetically superior results. CORRESPONDING AUTHOR: Ewa Timek, Advanced Plastic Surgery, 3855 Burton St SE A, Grand Rapids, MI 49546. (616) 323-3102. email protected
Tungol et al. (Thu,) studied this question.