This is from the October 2017 Aesthetic Surgery Journal. As it is breast cancer month, I thought this would be a good blog. The journal article was “Patient Reported Outcomes of Aesthetic and Satisfaction in Immediate Breast Reconstruction After Nipple Sparing Mastectomy With Implants and Fat Grafting.”
So, how can we make a prettier breast after you have a mastectomy?
The most common breast reconstructions are Tissue expander –> implant reconstruction or immediate reconstruction with an implant, called “direct to implant.” But the authors state there is little data beyond complication rates to compare these options. Is there an option which gives a prettier breast? And specifically, as fat grafting has become a common adjunct in nipple sparing mastectomies, how does this improve the aesthetic result?
This was a prospective cohort study. 59 patients underwent 113 reconstructions. Bilateral procedures were performed in over 90% of the patients. Only 7% of the patients were radiated. Mean follow up was one year.
Results?
- Patients had similar satisfaction with outcome
- The tissue expander to implant group had significantly larger final implant sizes. (450cc vs 540cc)
- Tissue expander to implant patients who did fat grafting had significantly higher satisfaction with outcome and pychosocial well being.
So?
The study indicates if you want to go bigger, likely a 2 stage tissue expander to implant reconstruction is better. Fat grafting gives a better aesthetic result. This is not really news- when you add fat, imagine you are making the comforter cover over the implant thicker. The more padding, the more it is soft, hides the underlying implant, and feels better.
What I found interesting in this was the study cohort. Almost all of them had bilateral mastectomies, they all had nipple sparing mastectomies, and few of them had radiation. For breast cancer reconstruction, symmetry is everything. I talk a lot with patients about how hard it is to match a reconstructed breast to a natural breast. And I hate radiation changes to the tissue. Seems like I am not the only one.