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Treatment of Irradiated Expanders: Protective Lipofilling Allows Immediate Prosthetic Breast Reconstruction in the Setting of Postoperative Radiotherapy

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  • Breast
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Abstract

Background

Immediate two-stage prosthetic breast reconstruction in the setting of postmastectomy radiotherapy (PMRT) currently is hardly achieved with the fast-track expander exchange proposed by Cordeiro and colleagues or the delayed-immediate breast reconstruction proposed by Kronowitz and Robb. Each of these techniques has important drawbacks and complications. To overcome these problems, the authors in 2011 described lipofilling on irradiated expanders in patients undergoing unplanned PMRT (Cagliari University Hospital [CUH] protocol) for early breast cancers with specific risk factors. The authors report their experience after expanding the use of such a protocol for any immediate expander/implant reconstruction in a patient undergoing PMRT.

Methods

The timing for advanced breast cancer involves immediate reconstruction with a tissue expander, complete tissue expansion, radiotherapy (RT) after neoadjuvant chemotherapy starting 2–3 months after mastectomy, one or two fresh fat-grafting sessions at least 6 weeks after RT, and an expander-implant exchange with anterior capsulectomy at least 3 months after the completion of fat grafting. The timing for early breast cancers with specific risk factors involves immediate reconstruction with a tissue expander, complete tissue expansion during postoperative chemotherapy, RT 6 months after mastectomy, one or two fat-grafting sessions 6 weeks after RT, and an expander-implant exchange with anterior capsulectomy at least 3 months after the completion of fat grafting. From 2008 to 2012, 16 patients undergoing total mastectomy and immediate expander-implant breast reconstruction with subsequent PMRT were treated according to the CUH protocol.

Results

The results have been extremely encouraging, with rates of ulceration and implant exposure in the radiotreated area dropping to 0 %. These results were retrospectively compared with those for a control group of 16 patients who underwent immediate implantation of an expander. In this latter group, the extrusion rate of the implant in the end was 31.25 %, and this was statistically significant (p < 0.03). The shape and symmetry also were significantly better in the lipofilled patients.

Conclusion

Protective lipofilling on irradiated expanders appears to be a valid technique for avoiding ulceration and implant exposure after PMRT while allowing a complete expansion.

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.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Section of Plastic Surgery, Department of Surgery, Cagliari University Hospital, Cagliari, Italy

    Diego Ribuffo & Matteo Atzeni

  2. Unit of Plastic Surgery, IRCCS San Gallicano Hospital, Rome, Italy

    Maristella Guerra & Stefania Bucher

  3. Department of Radiology, Cagliari University Hospital, Cagliari, Italy

    Carola Politi & Maura Deidda

  4. Unit of Clinical Oncology, Cagliari University Hospital, Cagliari, Italy

    Francesco Atzori, Mariele Dessi & Clelia Madeddu

  5. Unit of Oncological Radiotherapy, “Businco” Oncological Hospital, Cagliari, Italy

    Giancarlo Lay

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  1. Diego Ribuffo
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  2. Matteo Atzeni
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  3. Maristella Guerra
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  4. Stefania Bucher
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  10. Giancarlo Lay
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Correspondence to Matteo Atzeni.

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Ribuffo, D., Atzeni, M., Guerra, M. et al. Treatment of Irradiated Expanders: Protective Lipofilling Allows Immediate Prosthetic Breast Reconstruction in the Setting of Postoperative Radiotherapy. Aesth Plast Surg 37, 1146–1152 (2013). https://doi.org/10.1007/s00266-013-0221-2

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  • DOI: https://doi.org/10.1007/s00266-013-0221-2

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