Fat Graft Replacement for Reducing Implant Size May Decrease Radiotherapy-Related Complications in Prepectoral Expander-to-Implant Breast Reconstruction

There is obvious requirement for the improvement of expander-to-implant breast reconstruction due to the high rate of complication caused by radiotherapy. We aimed to decrease the complications by applying fat graft to obtain thicker mastectomy flaps and more importantly, to replace the part of definitive implant volume with fat tissue. Patients who underwent immediate pre-pectoral expander-to-implant placement for breast reconstruction were included in the study. In the fat graft group, two sessions of fat grafting procedure were applied after radiotherapy to decrease the volume of definitive implant while no additional intervention was executed to the no fat graft group. Patients were evaluated for wound dehiscence, skin necrosis, infection, implant loss, rippling, capsular contracture and secondary interventions. The fat graft group demonstrated statistically significantly lower incidence of wound dehiscence, skin necrosis, infection, implant loss, rippling, and capsular contracture compared to the no fat graft group (P < 0,05), despite similar baseline characteristics and reconstructive protocols. Autologous fat grafting prior to implant exchange was associated with a substantial reduction in the rates of wound dehiscence, skin necrosis, infection, implant loss, rippling and capsular contracture compared to standard implant exchange without fat grafting in prepectoral breast reconstruction.