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Autologous Fat Grafting And The Occurrence Of Capsular Contracture In The Reconstructed Irradiated Breast
Shanique A. Martin, BS1, Alan Nguyen, BS2, Lawrence Cai, MD, MS2, Ruth Tevlin, MB BAO BCh, MRCSI, MD2, Gordon Lee, MD2, Rahim Nazerali, MD, MHS2.
1Stanford University School of Medicine, Palo Alto, CA, USA, 2Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA, USA.

PURPOSE: Capsular contracture following prosthetic breast reconstruction is known to occur at higher rates in patients who have received radiation therapy. Autologous fat grafting (AFG) has been demonstrated to reverse radiation induced tissue fibrosis, however its effects on the occurrence of capsular contracture has not been well studied. Here, we explored the effect of AFG on the occurrence of capsular contracture in the setting of two-stage implant based reconstruction and postmastectomy radiation therapy (PMRT). The primary aim of our study was to determine if AFG at the time of second stage reconstruction prevented the occurrence of capsular contracture in previously irradiated breasts. The secondary aim was to determine if AFG had an effect on the occurrence of other post-operative complications. METHODS: A retrospective chart review of patients who underwent immediate tissue expander (TE) placement followed by PMRT and eventual second stage implant-based reconstruction at our institution between January 2012 and December 2016 was performed. Patients were divided into two cohorts based on whether or not AFG was performed at the time of second stage surgery. The occurrence of capsular contracture as well as other post-operative complications, including surgical site infection, wound dehiscence, skin necrosis, reoperation and implant loss was recorded. RESULTS: Overall 57 patients were included, 25 (43.9%) of whom underwent fat grafting at the time of second stage reconstruction with the remaining 32 receiving only TE implant exchange. All patients underwent submuscular implant placement and acellular dermal matrix was used in 34 breasts (59.6%). The mean post-operative follow up was 1.64 years. There was no significant difference in the prevalence of medical comorbidities between the two cohorts. The observed complication rate following second stage reconstruction was 38.6%, with no significant difference noted between the two cohorts (p = 0.641). The most prevalent complication was capsular contracture, occurring in 16 patients (28.0%), 10 of whom had received fat grafting (Table 1). Surgical site infection (8.7%) and wound dehiscence (3.5%) were the only other complications observed, neither of which varied significantly by study cohort. Multivariate logistic regression analysis demonstrated that fat grafting did not significantly influence the occurrence of capsular contracture in this patient population. CONCLUSION: Implant based reconstruction of the irradiated breast is associated with high post-operative complication rates, particularly capsular contracture, surgical site infection and implant loss. It is well understood that AFG reduces radiation induced dermatitis but there is currently insufficient clinical data reporting the effect of AFG on the occurrence of capsular contracture. The results of our study did not demonstrate a protective effect of AFG on the development of capsular contracture in previously irradiated breasts. The next stage of our study is to increase our study population to better examine the relationship between AFG and the development of capsular contracture following PMRT.Table 1. Observed Complications by the Occurrence of Fat Grafting at the time of Secondary Reconstruction

Without
Fat Grafting
(n = 32)
With
Fat Grafting
(n = 25)
p-valuea
Any Complication11 (34.4)11 (44.0)0.641
Infection4 (12.5)1 (4.0)0.513
Dehiscence2 (6.2)0 (0.0)0.584
Capsular Contracture6 (18.8)10 (40.0)0.140
Salvage Reoperation3 (9.4)2 (8.0)1.000
Implant Reconstruction Failure5 (15.6)5 (20.0)0.936
aChi-squared test


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