Secondary Fat Grafting in Breast Reconstruction: Comparison Between After Autologous Flap and After Silicone Implant

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Patient-Reported Outcomes

Background:

• Secondary fat grafting is increasingly utilized in breast reconstruction.
• Patient satisfaction and well-being are crucial metrics for evaluating reconstructive outcomes.
• Previous studies have explored fat grafting, but comprehensive analysis across different reconstruction types is ongoing.

Purpose of the Study:

• To evaluate the impact of secondary fat grafting on patient satisfaction and well-being.
• To compare outcomes between flap- and implant-based breast reconstruction with and without secondary fat grafting.
• To assess specific domains of well-being, including breast satisfaction, outcome satisfaction, psychosocial well-being, and sexual well-being.

Main Methods:

• A cohort of 162 patients undergoing postmastectomy breast reconstruction were divided into four groups: Flap-Fat Grafting (Flap-FG), Flap-alone (Flap-only), Implant-Fat Grafting (Imp-FG), and Implant-alone (Imp-only).
• Secondary fat grafting was performed for patients dissatisfied with their initial reconstruction.
• The BREAST-Q questionnaire was administered one year postoperation to assess patient-reported outcomes.

Main Results:

• A total of 139 patients (85.8% response rate) completed the questionnaire.
• Secondary fat grafting improved outcomes in both flap and implant reconstructions.
• The Imp-FG group showed significant improvements in all BREAST-Q domains compared to the Imp-only group (P < 0.001–0.041).
• The Flap-FG group demonstrated significant improvement in outcome satisfaction compared to the Flap-only group (P = 0.020).
• The Imp-FG group reported better psychosocial and sexual well-being than the Flap-FG group.

Conclusions:

• Secondary fat grafting is a valuable tool for improving patient satisfaction after breast reconstruction.
• It effectively corrects aesthetic deformities and enhances overall outcomes, particularly in implant-based reconstructions.
• Fat grafting addresses patient dissatisfaction by improving breast shape, size, and contour irregularities.