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Fat necrosis after breast-conserving oncoplastic surgery
Haruka Nakada1, Masayuki Inoue1, Kazushige Furuya1
1Department of Breast Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, 400-8506, Japan.
Breast Cancer (Tokyo, Japan)
|August 29, 2018
Summary
Fat necrosis is a complication of breast surgery, particularly oncoplastic procedures. Selecting grafts with good blood supply is crucial to minimize its incidence and severity.
Area of Science:
- Oncologic surgery
- Plastic and reconstructive surgery
- Breast surgery
Background:
- Fat necrosis is a common complication following breast surgery, potentially mimicking recurrence and impacting patient quality of life.
- The frequency and severity of fat necrosis are critical factors for patient counseling, yet data remain limited.
Purpose of the Study:
- To assess the incidence and severity of fat necrosis in patients undergoing breast surgery, with a focus on oncoplastic techniques.
- To compare fat necrosis rates across different reconstructive methods used in breast-conserving surgery.
Main Methods:
- A retrospective study of 1476 patients who underwent breast surgery between 2000 and 2012.
- Fat necrosis was evaluated using mammographic and physical findings, with a grading system (G0-G4) established.
- Surgical procedures included mastectomy, breast-conserving surgery (BCS) with various flap reconstructions (pedicled fat flap, free dermal fat flap) and defect repairs.
Main Results:
- Breast-conserving surgery was performed in 73% of patients, often utilizing oncoplastic procedures.
- Fat necrosis incidence varied significantly by reconstruction method: 4.6% without replacement, 16% with pedicled flaps, and 100% with free dermal fat grafts.
- Severe fat necrosis (G3-G4) was more frequent with free dermal fat grafts (25%) than pedicled flaps (2.9%). Inframammary adipofascial flaps showed a higher incidence (56%) of fat necrosis compared to other pedicled flaps.
Conclusions:
- Breast-conserving oncoplastic surgery is associated with a risk of delayed fat necrosis.
- The choice of reconstructive technique significantly influences the incidence and severity of fat necrosis.
- Prioritizing fat grafts with robust blood supply is recommended for defect replacement in breast-conserving therapy to mitigate fat necrosis.
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