Surgical Outcome and Cosmetic Results of Autologous Fat Grafting After Breast Conserving Surgery and Radiotherapy for Breast Cancer: A Retrospective Cohort Study of 222 Fat Grafting Sessions in 109 Patients

Background: Breast conserving surgery (BCS) and radiotherapy (RT) often lead to breast deformity. Reconstruction of these defects is a surgical challenge. Lately, the popularity of autologous fat grafting in these patients is growing. The purpose of this study was to assess clinical outcomes and aesthetic results of autologous fat grafting after BCS and RT. Materials and Methods: A database of all patients who underwent fat grafting after BCS and RT was prospectively maintained. Patient demographics, clinical and surgical characteristics and intra- and postoperative complications were analysed. Preoperative and 6-month postoperative photographs were evaluated by a four-member expert-panel assessing the aesthetic outcome (Harvard scale, five-point aesthetic scale and an overall score). Results: Between June 2008 and January 2016, 109 consecutive patients (114 breasts) underwent 222 fat grafting procedures. The mean clinical postoperative follow-up was 26 ± 19 months (range 10–97). The median number of fat grafting sessions sufficient for a satisfactory surgical result was two (range 1–6). Localized infections occurred in four patients, all treated effectively with oral antibiotics. Fat necrosis that required excision under local anaesthesia occurred once. The overall cosmetic appearance was rated 5.1/10 before and 7.2/10 after reconstruction (p < 0.01). A significant improvement was noted in breast symmetry, volume, shape and scarring. Conclusion: Fat grafting after BCS and RT provides significant aesthetic improvement of the breast. It has a positive effect on the postsurgical scar and irradiated tissue and helps to restore the volume deficit, which makes it suitable as a reconstructive approach in this patient group. Level of evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.