Secondary Fat Grafting in Breast Reconstruction: Comparison Between After Autologous Flap and After Silicone Implant.

Background: This study aimed to evaluate the impact of secondary fat grafting on patient satisfaction and well-being using the BREAST-Q, in patients who underwent flap- or implant-based breast reconstruction.

Methods: The patients who underwent postmastectomy breast reconstruction were divided into 4 groups based on the reconstruction technique: flap followed by fat grafting (Flap-FG), flap alone (Flap-only), implant followed by fat grafting (Imp-FG), and implant alone (Imp-only). Secondary fat grafting was performed for those dissatisfied with their initial reconstruction. One year postoperation, patients completed the BREAST-Q questionnaire, assessing breast satisfaction, outcome satisfaction, psychosocial well-being, and sexual well-being, with scores ranging from 0 to 100.

Results: Of the 162 patients, 139 responded to the questionnaire (response rate: 85.8%), including 14 in the Flap-FG group, 38 in the Flap-only group, 23 in the Imp-FG group, and 64 in the Imp-only group. Secondary fat grafting improved scores in both flap- and implant-reconstructed breasts, with the Imp-FG group showing significant improvements in all domains compared with the Imp-only group, including breast satisfaction (P = 0.007), outcome satisfaction (P = 0.041), psychosocial well-being (P < 0.001), and sexual well-being (P < 0.001). The Flap-FG group showed significant improvement only in outcome satisfaction (P = 0.020) compared with the Flap-only group. The Flap-only group had higher breast satisfaction scores than the Imp-only group (P = 0.049), whereas the Imp-FG group had better psychosocial and sexual well-being scores than the Flap-FG group.

Conclusions: Secondary fat grafting is highly useful in improving patient satisfaction by correcting breast shape, size, and deformities in cases where dissatisfaction exists with the initial breast reconstruction.