Fat Grafting in Postmastectomy Breast Reconstruction with Expanders and Prostheses in Patients Who Have Received Radiotherapy: Formation of New Subcutaneous Tissue

BACKGROUND: In secondary mammary reconstruction in irradiated patients, the use of expanders and prostheses is controversial, given that radiotherapy increases tissue fibrosis and capsular contracture. The authors assessed the usefulness of tissue expansion, prostheses, and fat grafting in patients who had received radiotherapy. METHODS: The authors conducted a study of 65 mastectomized patients (age range, 34 to 62 years) who had received radiotherapy with a 6-MeV electron accelerator. In the first operation, they inserted the Natrelle 133-MV expander (Allergan, Inc., Irvine, Calif.) endoscopically under the pectoralis major at the end of the mastectomy scar and performed total immediate expansion. The authors injected a mean quantity of 150 +/- 25 cc of fat in the upper quadrants between the skin and the muscle and also inside the muscle. After 3 months, they removed the expander through the same incision, inserted the McGhan Style 410 cohesive silicone prosthesis, and injected a mean 150 +/- 30 cc of fat in the lower quadrants. In the third stage, the nipple-areola complex was reconstructed. RESULTS: Mean follow-up was 1 year, with controls after 1 week, 1 month, 3 months, and 12 months. No complications were recorded with the fat injections. Patients' mean satisfaction rating was 4 on a scale of 1 (low) to 5 (high), and the capsular contracture was never above 1 on the Baker classification. CONCLUSION: In mastectomized patients who received radiotherapy, fat grafting in addition to traditional tissue expander and implant breast reconstruction achieves better reconstructive outcomes with the creation of new subcutaneous tissue, accompanied by improved skin quality of the reconstructed breast without capsular contracture.