Mastectomy, breast reconstruction with lipofilling gives good results. But it’s not for everyone
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Breast reconstruction after mastectomy for cancer using only your own fat, without resorting to implants. It is the third possible way of onco-plastic reconstruction, which is based solely on lipofilling. And now a study published on Jama Surgery shows that the patients who have been able to use it are more satisfied and report fewer complications than those who have had a “classic” reconstruction with prostheses.
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The Dutch study
The trial involved 171 patients operated on with mastectomy for breast cancer between 2015 and 2021 in 7 hospitals in the Netherlands: 91 performed lipofilling and 80 reconstruction with prostheses. Of these, 64 and 68 women completed follow-up, respectively, the mean age for both groups was 49 years, and none had radiotherapy after surgery.
One year later, the impact of the intervention on their quality of life was assessed using the BREAST-Q questionnaire, which considers 5 different aspects. The score was higher for the first group in all domains, and significantly higher in three: the degree of satisfaction with the breast, the physical well-being (relative to the chest area), the degree of satisfaction with the outcome. From an oncological point of view, no serious adverse events were observed in either group.
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Who is reconstruction with lipofilling for?
“There is a need for new, less invasive reconstructive techniques – write the researchers at the Maastricht University Medical Center – and our results indicate that reconstruction with lipofilling in patients with breast cancer is a safe and effective option. This news encourages it to be proposed as a third option”. However, it must be said that it is not for all cases, as he explains to Salute Mario Rietjens, Director of the Complex Structure of Plastic and Reconstructive Surgery at the European Institute of Oncology and professor at the University of Milan. “Lipofilling has been used for several years, but above all in association with reconstruction with prostheses, to correct small defects.
To use it as the only technique for reconstruction, three conditions are necessary: the breast must be small, no more than a second-third size; the patient must have so much fat available to be taken from other locations, such as the belly and legs; you must be willing to undergo numerous operations, usually 4 to 7. These are small and short operations, but they still require general anesthesia”.
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How lipofilling and nipple reconstruction takes place
Patients who can access lipofilling must therefore be carefully selected. The fat to be taken, for example, must be much more than that to be injected, both because it must be purified and because 30-40% is reabsorbed in the 3 months following the operation. And this also explains why more sessions are needed: “The first step is the mastectomy and the insertion of the expander in the post-operative period, necessary to stretch the skin and arrive at the same volume as the contralateral breast – continues Rietjens – At that point we can proceed with the first stage of lipofilling: the expander is deflated by 100 cc and 200 cc of fat is injected. The fat must be taken from a different point each time. We proceed in this way until the expander, now completely deflated, is removed” .
This is followed by the ‘tattooing’ of the areola and the reconstruction of the nipple, which can take place in two ways, explains the plastic surgeon: “If the nipple of the other breast is small, the tissue of the skin itself is used; if instead it is large , a small sample is taken and it is grafted onto the reconstructed breast, in order to obtain two smaller and similar nipples”. Another possibility of reconstructing the nipple, currently being studied overseas, is the use of 3D printed absorbable structures (we talked about it in this article).
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In a small pilot study conducted in 2017 by Rietjens and colleagues on 19 cases of onco-plastic reconstruction with lipofilling only, it emerged that the patients were extremely happy not to have had to resort to prostheses. “Those who take this path eventually arrive at a good result, because the breasts change naturally over time and age together with the body. Furthermore, there is no problem of checking and replacing the implants, which deteriorate. Now – concludes the expert – we too have started a study similar to the one published in Jama Surgery, to compare the results of the different techniques”.
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