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FAT GRAFTING IN POST MASTECTOMY BREAST RECONSTRUCTION WITH EXPANDERS AND PROSTHESIS IN PATIENTS WHO HAVE RECEIVED RADIOTHERAPY.: Formation of new subcutaneous tissue.
MedLine Citation:
PMID:  19910853     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND METHODS:: In secondary mammary reconstruction in irradiated patients the use of expanders and prosthesis is controversial, given that radiotherapy increases tissue fibrosis and capsular contracture. Previously, in non-irradiated patients who received reconstruction with tissue expansion, prosthesis, and fat grafting to increase subcutaneous tissue, we noted a marked improvement in skin quality. Here, we assess the usefulness of this technique in patients who had received radiotherapy.Sixty-five mastectomized patients (age range 34 - 62 years) who had received radiotherapy with a 6 MEV electron accelerator. In the first operation we inserted the McGhan 133 MV expander endoscopically under the pectoralis major at the end of the mastectomy scar and performed total immediate expansion. We injected a mean quantity of 150cc+/- 25cc of fat in the upper quadrants between the skin and the muscle and also inside the muscle. After three months we removed the expander via the same incision, inserted the McGhan Style 410 cohesive silicone prosthesis, and injected a mean of 150cc+/- 30cc of fat in the lower quadrants. In the third stage, the nipple-areola complex was reconstructed. RESULTS: Mean follow-up was one year, with controls after one week, one month, three months and twelve months. No complications were recorded with the fat injections. Patients' mean satisfaction rating was 4 on a scale of 1 (low) to 5 (high) and the capsular contracture was never above 1 on the Baker Classification. CONCLUSION: In mastectomized patients who received radiotherapy, the use of fat grafting in addition to traditional tissue expander and implant breast reconstruction achieves better reconstructive outcomes with the creation of new subcutaneous tissue, accompanied by improved skin quality of the reconstructed breast without capsular contracture.
Authors:
Jose M Serra-Renom; Juan Muñoz Del Olmo; Jose M Serra-Mestre
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2009-11-13
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  -     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Aesthetic Plastic Surgery Department, Hospital Quirón. Barcelona. Universidad Internacional de Cataluña (U.I.C.).
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