Improved patient-reported outcomes after autologous fat transplantation and corrective surgery after breast surgery

Figures & data

Table 1. Patient characteristics.

Age at baseline (y)	52.7* (31.1–71.3)
BMI at baseline (kg/m^2)	24.7* (17–32.4)
BMI at follow-up (kg/m^2)	25.3* (18.8–34.3)
Previous breast surgery (n)	48
Breast-conserving surgery	25
Mastectomy + Immediate reconstruction with prosthesis	10
Mastectomy + Delayed reconstruction with prosthesis	2
Mastectomy + DIEP	1
Mastectomy + LD	7
Prophylactic mastectomy + Immediate reconstruction with prosthesis	2
Prophylactic mastectomy + Immediate reconstruction with prosthesis^†	1
Radiotherapy (n)	38
Time from radiotherapy to AFT (y)	3.6* (1.1–22.1)

n = 48, DIEP: deep inferior epigastric perforator flap; LD: latissimus dorsi flap; *Median; †Previous cancer surgery.

Figure 1. Flow diagram of patients’ participation in the study. Boxes on the left show the number of patients completing the study-specific questionnaire (SSQ) at each time point. Boxes in the middle show the number of patients participating in the study. Boxes on the right show the number of patients excluded and drop-outs.

Figure 2. Mean line plots for Q1–Q4 and Q9–Q20. The mean line plots for each item at each time point are shown for all patients who completed the SSQ.

Table 2. Results for Q1–Q4 and Q9–Q20 on sensitivity, pain, appearance, softness, trouble finding a good-fitting bra and willingness to participate in physical activities.

		1     …    7		BL	2 years	Min	Max	SD
Q1	How is the sensation in the nipple area?	Normal	Reduced	4.10	4.55	−3.0	5.0	1.5
Q2	How is the sensation in the breast skin?	Normal	Reduced	4.16	3.95	−4.0	3.0	1.6
Q3	How is your ability to feel sexual sensation in the breasts?	Normal	Reduced	4.91	4.70	−5.0	5.0	1.8
Q4	Do you have pain in the breasts/breast region?	Every day	Never	5.11	5.53	−3.0	4.0	1.7
Q9	What do you think about the size of your breasts?	Too small	Too big	2.45	3.21	−2.0	4.0	1.4
Q10	Are the breasts of equal size?	Very dissimilar	Very similar	2.71	3.60	−3.0	5.0	2.0
Q11	What do you think of the shape of your breasts?	Very ugly	Very nice	2.70	4.00	−3.0	5.0	2.0
Q12	Are the breasts of equal shape?	Very dissimilar	Very similar	2.25	3.70	−2.0	5.0	1.7
Q13	What do you think about the softness of your breasts?	Very hard	Very soft	3.55	4.28	−2.0	4.0	1.5
Q14	Are you satisfied with the appearance of your breasts?	Not at all	Very satisfied	2.37	4.15	−1.0	6.0	1.6
Q15	What do you think about the appearance of the breast when you wear clothes?	Very ugly	Very nice	4.30	5.63	−3.0	5.0	1.5
Q16	What do you think of the breast's appearance when you are wearing swimwear / a bra?	Very ugly	Very nice	3.25	5.20	−1.0	6.0	1.6
Q17	What do you think of the breast's appearance when you are naked?	Very ugly	Very nice	2.31	3.72	−2.0	5.0	1.7
Q18	What do you think of the scars from previous cancer surgery?	Very ugly	Very nice	2.98	3.85	−3.0	5.0	1.8
Q19	Do you have trouble finding a bra that fits your breasts?	Very hard	Not hard at all	3.96	5.11	−4.0	6.0	2.2
Q20	Do your breasts affect your willingness to swim in public environments (swimming pool, beach, etc.) or participate in gymnastics and similar activities?	Negative	Positive	3.39	5.03	−2.0	5.0	1.8

The questions were answered on a 7-point Likert scale. Mean score at baseline (BL) and a 2-year follow-up are shown. Min: minimum change in score between baseline and 2 years. Max: maximum change in score between baseline and 2 years. Negative numbers indicate lower score at the 2-year follow-up compared to baseline. SD: Standard deviation in the change between baseline and 2 years.

Table 3. Q1–Q4 and Q9–Q20.

	1 year follow-up				2 years follow-up				Radiotherapy 2 years follow-up				No additional surgery 2 years follow-up
	ECh	SE	p	CI	ECh	SE	p	CI	ECh	SE	p	CI	ECh	SE	p	CI
Q1	0.3	0.25	0.190	−0.17–0,83	0.3	0.23	0.160	−0.13–0.80	0.4	0.27	0.190	−0.18–0.89	0.4	0.24	0.152	−0.13–0.84
Q2	−0.2	0.24	0.405	−0.68–0,28	−0.2	0.22	0.295	−0.68–0.21	−0.4	0.23	0.077	−0.86–0.04	−0.3	0.23	0.269	−0.71–0.20
Q3	0.2	0.29	0.479	−0.37–0,78	−0.2	0.26	0.451	−0.71–0.32	0.0	0.29	0.999	−0.57–0.57	−0.1	0.27	0.621	−0.66–0.40
Q4	0.5	0.22	0.021	0.08–0,97	0.6	0.22	0.005	0.19–1.05	0.6	0.24	0.014	0.13–1.09	0.6	0.23	0.015	0.12–1.02
Q9	0.5	0.17	0.003	0.18–0,85	0.7	0.16	<0.001	0.34–0.98	0.7	0.18	0.001	0.29–1.01	0.8	0.17	<0.001	0.41–1.10
Q10	1.0	0.26	<0.001	0.53–1,56	0.8	0.25	0.002	0.29–1.27	0.8	0.26	0.005	0.23–1.28	0.9	0.26	0.001	0.37–1.40
Q11	0.9	0.24	<0.001	0.43–1,40	1.1	0.23	<0.001	0.66–1.59	1.2	0.26	<0.001	0.73–1.76	1.0	0.25	<0.001	0.52–1.51
Q12	1.0	0.26	<0.001	0.48–1,52	1.3	0.25	<0.001	0.77–1.76	1.4	0.27	<0.001	0.82–1.92	1.3	0.27	<0.001	0.80–1.86
Q13	0.4	0.24	0.114	−0.09–0,86	0.8	0.23	0.001	0.32–1.22	0.9	0.24	<0.001	0.45–1.40	0.8	0.24	0.001	0.31–1.26
Q14	1.3	0.22	<0.001	0.87–1,77	1.7	0.22	<0.001	1.24–2.10	1.6	0.23	<0.001	1.14–2.07	1.6	0.20	<0.001	1.15–1.97
Q15	1.5	0.21	<0.001	1.10–1,93	1.3	0.20	<0.001	0.95–1.75	1.5	0.19	<0.001	1.14–1.91	1.2	0.20	<0.001	0.82–1.62
Q16	1.9	0.23	<0.001	1.40–2,32	2.0	0.22	<0.001	1.57–2.45	2.0	0.22	<0.001	1.55–2.45	2.0	0.23	<0.001	1.53–2.43
Q17	1.5	0.23	<0.001	1.04–1,95	1.4	0.22	<0.001	0.94–1.81	1.4	0.24	<0.001	0.96–1.91	1.3	0.22	<0.001	0.84–1.74
Q18	0.9	0.23	<0.001	0.46–1,39	1.0	0.23	<0.001	0.54–1.45	1.1	0.25	<0.001	0.63–1.62	0.9	0.23	<0.001	0.46–1.38
Q19	1.2	0.28	<0.001	0.59–1,72	1.1	0.27	<0.001	0.59–1.68	1.3	0.29	<0.001	0.77–1.92	1.0	0.28	0.001	0.45–1.59
Q20	1.3	0.27	<0.001	0.74–1,81	1.5	0.26	<0.001	1.03–2.07	1.5	0.28	<0.001	0.97–2.09	1.5	0.27	<0.001	0.95–2.03

Statistical analysis of questions in table 2 with MMRM for patients who completed the study-specific questionnaire at baseline and after 2 years (n = 38). Estimated mean change (ECh) from baseline to follow-up. Significant level was set on p ≤ 0.05 with a confidence interval (CI) on 95%. Significant items are bold. SE: Standard error. Radiotherapy 2 years follow-up = irradiated patients only. No additional surgery 2 years follow-up = patients that had not undergone major additional ipsilateral surgical procedures.

Figure 3. Q5–Q8 focusing on sexuality and willingness to be naked. The graphs show the percentage of answers in each category, for each item, at baseline and after 2 years. The ordinal trend is the chance of scoring one category more positive than one category more negative at follow-up. Significant items are given in boldface. CI: confidence interval.

Figure 4. Results for the eight domains of SF-36 of the study population and the age matched reference population of Swedish women (n = 3260). PF: physical functioning; RP: physical role functioning; BP: bodily pain; GH: general health; VT: vitality; SF: social role functioning; RE: emotional role functioning; MH: mental health.

Figure 5. A 31-year-old women that presented with a scar retraction and volume deficiency 3.6 years after breast conserving surgery and radiotherapy (left). She underwent three AFT procedures with totally 150 ml fat. 2.2 years post-operative the scar is not visible and the symmetry is better (right).

Figure 6. A 66-year-old woman with bilateral defects after BCS and RT (left). Time from RT to AFT was 2.6 years for the left breast and 1 year for the right breast. She underwent two AFT procedures to each breast with totally 69 ml to the left side and 100 ml to the right. In addition, she underwent mastopexy on the right side. Post-operative images from the 2-year follow-up are shown to the right.