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

BACKGROUND: There is obvious requirement for the improvement of expander-to-implant breast reconstruction due to the high rate of complications caused by radiotherapy. OBJECTIVES: We aimed to decrease the complications by applying fat graft to obtain thicker mastectomy flaps and, more importantly, to replace part of the definitive implant volume with fat tissue. METHODS: Patients who underwent immediate prepectoral expander-to-implant placement for breast reconstruction were included in the study. In the fat graft group, 2 sessions of fat grafting were performed after radiotherapy to decrease the volume of definitive implant, whereas no additional intervention was performed for the no fat graft group. Patients were evaluated for wound dehiscence, skin necrosis, infection, implant loss, rippling, capsular contracture, and secondary interventions. RESULTS: The fat graft group demonstrated a statistically significant lower incidence of wound dehiscence, skin necrosis, infection, implant loss, rippling, and capsular contracture compared to the no fat graft group (P < .05), despite similar baseline characteristics and reconstructive protocols. CONCLUSIONS: Autologous fat grafting before 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.