From the Guidelines
Fat grafting (lipofilling) can be performed on a breast that has previously undergone radiation therapy, as it is considered a viable option for improving tissue quality and aesthetic outcomes in radiated breasts. This procedure is particularly useful in cases where autologous tissue reconstruction is preferred over implant-based reconstruction, as it can help reduce radiation-induced fibrosis and improve skin elasticity 1.
Key Considerations
- The procedure involves harvesting fat from another part of the patient's body, processing it, and then carefully injecting it into the radiated breast tissue.
- Multiple sessions may be required to achieve optimal results, typically spaced 3-6 months apart, as not all transferred fat will survive.
- Patients should be aware that while generally safe, potential complications include fat necrosis, oil cysts, calcifications, and variable fat retention rates.
- The procedure is best performed after radiation effects have stabilized, typically at least 6-12 months after completion of radiation therapy.
Radiation Therapy and Breast Reconstruction
According to the NCCN guidelines 1, tissue expansion of irradiated skin can result in a significantly increased risk of capsular contracture, malposition, poor cosmesis, implant exposure, and failed reconstruction. Therefore, autologous tissue reconstruction, including fat grafting, is often preferred in patients who have undergone radiation therapy.
Patient Selection and Counseling
Reconstruction selection is based on an assessment of cancer treatment, patient body habitus, obesity, smoking history, comorbidities, and patient concerns 1. Patients should be made aware of the potential benefits and risks of fat grafting, including the possibility of multiple sessions and potential complications. Smoking and obesity increase the risk of complications for all types of breast reconstruction, and patients should be counseled accordingly 1.
From the Research
Fat Grafting After Radiation Therapy
- Fat grafting, also known as lipofilling, can be performed on a breast that has previously undergone radiation therapy 2, 3, 4.
- However, the incidence of fat necrosis is higher in patients who have undergone radiation therapy, with one study reporting a 47.8% incidence of fat necrosis in previously irradiated patients 3.
- Another study found that patients with a history of radiation therapy had an increased incidence of repeat fat injections, with 36% of patients requiring repeat injections compared to 18% of patients without a history of radiation therapy 4.
Complications and Risks
- The complication rates after breast augmentation with fat grafting are low, with major complications such as hematoma, infection, and seroma occurring in less than 1% of patients 2.
- However, the rates of radiologic changes such as oil cysts, calcifications, and fat necrosis are higher, occurring in 6.5%, 4.5%, and 1.2% of patients, respectively 2.
- Fat grafting after radiation therapy may be associated with a higher rate of complications, including fat necrosis and the need for repeat injections 3, 4.
Clinical Applications and Outcomes
- Fat grafting is a safe and effective tool for secondary breast reconstruction, and can be used to improve contour, volume, and overall breast shape and symmetry 4, 5.
- The use of fat grafting in breast reconstruction is increasing, and it is important for breast cancer care providers to be aware of the potential complications and risks associated with this procedure 6, 5.