The Role of Autologous Fat Grafting in Delayed Breast Reconstruction Using Tissue Expanders.

Background: Delayed prosthetic breast reconstruction is commonly undertaken, but after radiotherapy it carries a higher risk of complications. Autologous fat grafting (AFG) improves the quality of the tissue, particularly after radiotherapy. The aim of this study was to assess the role of AFG in patients undergoing delayed breast reconstruction with tissue expanders as the first stage. Methods: This is a retrospective study of 58 patients (mean age 45 y, range 26-62 y) having delayed prosthetic breast reconstruction by tissue expansion as the first stage, at a tertiary hospital between January 2016 and November 2019. History of radiotherapy postmastectomy was recorded. Fifty-eight patients were divided into those who received fat grafting before tissue expander insertion and those who did not. Complications of both groups were analyzed. Results: Forty-one patients had tissue expanders inserted without fat grafting, whereas 17 patients had fat grafting before tissue expander insertion. Of these 17 patients (10 of whom also had postoperative radiotherapy) who had fat grafting before expander insertion, only 2 developed extrusion; both patients had radiation. Of 41 patients having tissue expansion insertion without fat grafting, 19 patients developed extrusion, and 14 of these 19 patients had radiation therapy. Conclusions: Clinical assessment of the mastectomy flaps is required before tissue expander insertion, and, if atrophic and scarred from previous infection, or, if the patient has undergone radiotherapy, AFG should be considered. Fat grafting reduced tissue expander extrusion in patients having delayed breast reconstruction, especially in patients who had radiation.