Long-Term Clinical and Aesthetic Results of a Systematic Fat Transfer Protocol for Total Breast Reconstruction after Nipple-Sparing Mastectomy

Background: Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. Methods: One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. Results: Groups were homogeneous for demographics (p > 0.05) but significantly different in number of fat transfer sessions (p < 0.001), mean volume of the first two treatments (p = 0.003), and mean total volume of injected fat (p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups (p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A (p = 0.003). Although a significant difference for total subscales was worse in group A (p = 0.004), the global score had a high rate evaluation in all groups (p = 0.145). Interrater reliability showed substantial agreement among all categories. Conclusion: Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results.