For breast cancer patients who have undergone radiation therapy, a new technique consisting of fat injection followed by implant placement may provide a much-needed alternative for breast reconstruction, reports a study in the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Fat grafting seems to reduce the radiation-induced complications in implants," according to the authors of the new study, led by Dr. Salgarello Marzja of University Hospital A. Gemelli in Rome. With further study, the combination technique may offer women who have undergone radiation therapy an effective new reconstructive option. Dr. Marzja and colleagues investigated the use of fat grafting to achieve better results with implant-based breast reconstruction after surgery plus radiation therapy for breast cancer. Because of an increased risk of complications, women who have undergone radiation therapy are usually not considered for reconstruction using implants.
Over a three-year period, researchers used the combination technique in 16 patients who underwent surgery followed by radiation therapy for breast cancer. Eleven underwent mastectomy and five had lumpectomy or other types of "breast-conserving" surgery. Reconstruction began at least three to six months after the completion of radiation therapy. In the fat grafting technique, fat was obtained by liposuction from one part of the body and injected into the radiation-treated area. The goal was to provide a "bed" of healthy tissue in the chest wall or remaining breast to receive the implant. All patients received two or three fat grafts. The final reconstruction, including implant placement, was performed only when the area was free of signs of radiation toxicity.
The results of the staged reconstruction technique were highly encouraging. The final appearance of the reconstructed breasts was rated excellent to good in 94 percent of patients. Patient satisfaction was rated high to very high. At an average follow-up of 15 months, there were no complications. All patients had good healing of the tissues surrounding the implant.
Adding radiation therapy after breast cancer surgery reduces the risk of recurrent breast cancer and increases the chances of survival. In response to recently revised treatment guidelines, the number of patients undergoing surgery followed by radiation for breast cancer is likely to increase significantly in the years ahead. However, radiation has toxic effects on tissues that can cause problems with healing. Women who have undergone radiation therapy are at increased risk of complications after breast reconstruction using implants. As a result, "autologous" reconstruction using the women's own tissues, which requires another operation to obtain graft tissue from the abdomen, is often their only option for breast reconstruction.
Although experience is limited so far, the new report suggests that initial fat grafting may enable successful implant-based reconstruction for the growing number of women who have undergone radiation therapy for breast cancer. "Fat grafting seems to reduce the radiation-induced complications in implants," Dr. Marzja and co-authors conclude. "However, larger studies with a longer follow-up are required to confirm our findings."