Reverse expansion-assisted high-quality autologous fat grafting in breast reconstruction: A retrospective comparative study.

Abstract

Reverse expansion (RE) combined with fat grafting (FG) is a relatively innovative method used for breast reconstruction following mastectomy for breast cancer. Using an expanded subcutaneous adipose tissue layer as the recipient area seems to promote the retention of subsequent grafts. To further validate, the study retrospectively compared clinical outcomes in patients who underwent FG with and without RE for breast reconstruction. This study included patients diagnosed with breast cancer who underwent unilateral mastectomy followed by breast reconstruction with high-quality autologous FG at our department between January 2019 and December 2023. The patients were divided into two groups, those who underwent FG plus RE group and those who underwent FG alone. Demographic and clinical characteristics, FG retention rates, BREAST-Q scores, and complications were compared in the two groups. The present study included 55 patients, 27 in the FG+RE group and 28 in the FG group. Preoperative scores and fat retention rates of the first FG did not differ significantly between these two groups (P>0.05 each). The retention rate of the second FG (i.e., the first FG after RE) was significantly higher in the FG+RE group than in the FG group (P<0.001). A comparison of BREAST-Q postoperative scores in the two groups showed that scores on two subscales, psychosocial well-being and satisfaction with breasts, were significantly superior in the FG+RE than in the FG group (P<0.05 each) CONCLUSIONS: Expander-assisted FG based on the RE strategy can improve graft retention and reduce the number of rounds of FG. Moreover, reverse expansion can result in sufficient skin and improve breast contouring without relying on patient compliance.