Top Line: The two main categories for breast reconstruction following mastectomy are implant-based and autologous flap (typically by transferring excess abdominal skin and fat along with its blood supply up and around to the chest wall).
The Study: Unfortunately around one in three women can experience complications with either of these techniques. The simply-named Dutch BREAST trial!https://jamanetwork.com/journals/jamasurgery/fullarticle/2802106 throws a third contender in the ring. An autologous fat transfer aims to create a natural looking breast requiring neither a foreign body nor a morbid surgery, which are often the culprits of said complications. Believe it or not, this trial has follow-up on 132 women successfully randomized to either an implant-based reconstruction over two stages or a gradual autologous fat transfer over several months (see figure 2). In the end, the primary outcome of quality of life measures were significantly higher in the autologous fat transfer group, though, of note, a higher mean breast volume was achieved with implant-based reconstruction (384 versus 300 cc). Other positive notes about autologous fat transfer are the absence of a foreign body source of infection and its ability to “naturally age and undergo ptosis and follow weight fluctuations, thereby maintaining a better symmetry with the contralateral breast.”
TBL:Autologous fat transfer offers a less invasive autologous option for breast reconstruction and achieves a better quality of life that only increases with time compared to implant-based reconstruction in a randomized trial. | Piatkowski, JAMA Surg 2023
The Study: Unfortunately around one in three women can experience complications with either of these techniques. The simply-named Dutch BREAST trial!https://jamanetwork.com/journals/jamasurgery/fullarticle/2802106 throws a third contender in the ring. An autologous fat transfer aims to create a natural looking breast requiring neither a foreign body nor a morbid surgery, which are often the culprits of said complications. Believe it or not, this trial has follow-up on 132 women successfully randomized to either an implant-based reconstruction over two stages or a gradual autologous fat transfer over several months (see figure 2). In the end, the primary outcome of quality of life measures were significantly higher in the autologous fat transfer group, though, of note, a higher mean breast volume was achieved with implant-based reconstruction (384 versus 300 cc). Other positive notes about autologous fat transfer are the absence of a foreign body source of infection and its ability to “naturally age and undergo ptosis and follow weight fluctuations, thereby maintaining a better symmetry with the contralateral breast.”
TBL:Autologous fat transfer offers a less invasive autologous option for breast reconstruction and achieves a better quality of life that only increases with time compared to implant-based reconstruction in a randomized trial. | Piatkowski, JAMA Surg 2023