Secondary Breast Reconstruction in Irradiated Patients: Prospective Trial Comparing DIEP to Brava Expansion and Fat Transplantation

BACKGROUND: Autologous tissue reconstruction of the breast is preferable after irradiation. Fat transplantation is a possible alternative. The aim of this prospective trial was to compare outcomes of deep inferior epigastric perforator (DIEP) flaps to Brava expansion and fat grafting, after mastectomy and irradiation. METHODS: Patients were recruited among the candidates for delayed breast reconstruction after mastectomy and irradiation and were given the same information on both methods. Twenty-six patients underwent DIEP reconstruction, and 31 patients had multiple fat grafting sessions after Brava external tissue expansion. Outcomes were evaluated using the BREAST-Q questionnaire and the Telemark Breast Score. RESULTS: Twenty-four of 31 patients in the fat graft group completed the study. Six to nine operative sessions were required to gain a mean volume of about 490 mL. The mean total operative time was 11.5 hours. Four patients in this group developed a new primary or metastatic cancer disease during the study. Twenty-four of 26 patients in the DIEP group completed the study. The mean total operative time was 8 hours. The mean volume of the reconstructed breast was 523 mL. Telemark Breast Score values showed similar improvements in both groups at short terms of 3 months in the Brava group and 6 months in the DIEP group. CONCLUSIONS: Supplementary surgical procedures are often needed in breast reconstruction after mastectomy with irradiation using Brava external expansion and fat grafting. Even though the aesthetic results evaluated by surgeons were comparable, patients were more satisfied with outcomes after DIEP reconstruction compared with Brava expansion and fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.