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Fat Grafting in Breast Reconstruction Improves Patient-Reported Outcomes--A Multicenter Prospective Analysis
Katelyn G. Bennett, MD1, Ji Qi, MS1, Hyungjin M. Kim, ScD1, Jennifer B. Hamill, MPH, MS1, Andrea L. Pucic, MD, MHS2, Edwin G. Wilkins, MD, MS1, Babak J. Mehrara, MD3, Jeffrey H. Kozlow, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Memorial Sloan Kettering Cancer Center, New York City, NY, USA.

PURPOSE: Fat grafting is used extensively in both implant-based and autologous breast reconstruction to improve contour of the breast mound. While many surgeons have found it to be a useful adjunct, an evaluation of the effects on patient-reported outcomes has not yet been performed. This study used prospective data to compare outcomes between patients who did and did not undergo adjunct fat grafting following breast reconstruction.
METHODS: Recruited from 10 sites, patients undergoing implant-based or autologous breast reconstruction were included. Each patient had two years of follow-up after the initial surgery and completed breast mound reconstruction during the first year. Patients who underwent fat grafting between year one and two were compared with those who did not. Patient-reported outcomes on breast reconstruction were evaluated preoperatively and at one and two years postoperatively, using the BREAST-Q questionnaires. Mixed effects regression models were performed to assess the relationship between fat grafting and outcomes of interest.
RESULTS: A total of 2,048 women were included, with 165 undergoing fat grafting between year one and two. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (p=0.007), psychosocial well-being (p=0.042), and sexual well-being (p=0.006) compared to those who did not receive subsequent fat grafting. However, at two years postoperatively, both cohorts groups had similar patient-reported outcomes.
CONCLUSION: Fat grafting following post-mastectomy breast reconstruction results in a significant improvement in patient-reported outcomes. Although patients undergoing fat grafting had poorer patient-reported outcomes prior to the procedure, they demonstrated significant improvement in outcomes afterwards.


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