Secondary breast reconstruction in small to medium-sized irradiated breasts: could Fat-Augmented LD (FALD) flap be a reliable alternative?

Background: Secondary breast reconstruction (BR) is recognized as challenging procedure particularly when radiotherapy (RT) has previously been performed. The aim of the study was to compare operative data and aesthetic outcomes between secondary irradiated and immediate BR using Fat-Augmented Latissimus Dorsi (FALD) flap. Methods: We conducted a prospective clinical study between September 2020 and September 2021. Patients were divided into 2 groups: Group A included secondary BR using FALD flap in previously irradiated breasts, while Group B immediate BR with FALD flap. Demographics and surgical data were compared and an aesthetic analysis was performed. Chi-square and t-test were performed for categorical and continuous variables respectively. Results: 20 FALD flap-based BR for each group were included. The two groups were found to be homogeneous for the demographic's variables. The difference in mean operative time (263.1 vs 265.1 min; p=0.467) and complications (p=0.633) among the two groups were not significant. There was statistically significant difference in term of immediate fat grafting volume in favor of group A (218.2 cc vs 133.0 cc; p<0.0001). Regarding aesthetic outcomes, the mean global score evaluation showed no statistically significant differences between groups (17.86 vs 18.21; p=0.209). Conclusion: Our study states that the FALD flap can be considered a reliable procedure for secondary reconstruction in previously irradiated breasts, although it is not indicated for patients with larger breasts. This surgical technique allowed us to achieve a totally autologous BR with good aesthetic results and low complication rates, even in secondary irradiated cases.