Safety of Large-Volume Immediate Fat Grafting for Latissimus Dorsi-Only Breast Reconstruction: Results and Related Complications in 95 Consecutive Cases

Background: Breast reconstruction with implants has proven serious complications, mostly in patients who have undergone radiotherapy. In these cases, autologous reconstruction is the technique of choice. Objectives: To study if breast reconstruction using latissimus dorsi and immediate fat grafting (LIFG) is a widely applicable technique for those cases in which an autologous reconstruction is desirable, but the use of microsurgical perforator flaps is not available. Methods: Data of 95 consecutive breast reconstructions from May 2014 to December 2018 were prospectively collected. All patients included in the study had a minimum follow-up of one year after completion of the reconstructive process. Results: The mean age of the patients was 48.57 years with an average follow-up of 20.65 months. The mean number of surgeries per patient was 1.61. In 47.4% of the cases, only LIFG surgery was required to accomplish the reconstructive process. The mean volume of fat graft used was 416.00 ± 145.79 cc. Relevant statistically significant differences in the volume of graft were found regarding the use of previous radiotherapy and the timing of reconstruction. Radiological fat necrosis nodes were the main complication (15.8%). However, their presence was significantly lower if no additional fat grafting sessions were necessary, though, unexpectedly, no relation was found in relation to the total amount of fat graft needed. Conclusions: LIFG has proved to be a safe and reliable method for total autologous breast reconstruction. Even when a medium to large size is required, a large volume of fat graft is accepted; thus, excellent results can be obtained. It is an interesting alternative for breast reconstruction, in addition to abdominal perforator flaps. Level of evidence IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Breast Surgery.