Autologous fat grafting with EVE device improves QoL after breast reconstruction

Using an external volume expansion (EVE) device to facilitate autologous fat grafting (AFG) for complete breast reconstruction may lead to slight improvements in quality of life (QoL) and breast volume, according to a recent study.

“In our study, we hypothesized that the use of an EVE device that used the Khouri protocol would be effective for breast reconstruction following mastectomy and achieve improved QoL,” said researchers. “Furthermore, we hypothesized that EVE and fat grafting could be a viable option for breast reconstruction as a standalone method.”

In 19 women (median age, 53.8 years) who had undergone breast cancer surgery and subsequent reconstruction, EVE use before AFG led to improved QoL. The satisfaction with breast domain of the BREAST-Q tool, for example, saw mean scores jump from 40±14.6 before surgery to 49±9.8 12 months after grafting. [J Plast Reconstr Aesthet Surg 2020;73:27-35]

A similarly slight improvement over time was reported for the sexual well-being domain (41±18.7 to 48±12). Stronger effects were observed for the psychosocial well-being (55±19 to 68±15.7) and physical well-being abdomen (73±15.5 to 87±27.2) subscores.

On the other hand, physical well-being chest (71±16.3 to 67±11.7) and satisfaction with the outcome (65±19.7 to 60±17.7) appeared to have deteriorated by the 12-month postoperative follow-up.

“Although the BREAST-Q scores for women who have undergone expansion and fat grafting were improved compared to preoperative values, the final postoperative scores were lower than those reported in the literature for conventional methods of postmastectomy breast reconstruction,” the researchers pointed out.

For instance, the final subscore of 48.72 in the satisfaction with breasts domain in the current study paled in comparison to the 2016 average of 64.92, in the same domain, for conventional breast reconstruction. The latter figure was obtained from a 2016 cohort study by Dean and Crittenden.

EVE+AFG scores continued to underperform in the areas of psychosocial well-being (68.11 vs 71.47), physical well-being chest (66.88 vs 74.78) and sexual well-being (48.25 vs 54.17) than the 2016 series.

“[I]t can be seen that the EVE plus autologous fat graft has less effect on QoL than a conventional breast reconstruction,” the researchers noted.

There were three cases of mechanical failure of the device. More than half of the participants also reported experiencing skin irritation, ranging from mild cases to erythema, itch and bullous lesions that were haemorrhagic or contained serous fluid. Donor site morbidity was minimal, though two cases of abdominal haematomas were reported and were managed conservatively. There was one documented case of fat necrosis and none of breast cancer recurrence.

“The current study suggests that EVE and AFG as a methodology for breast reconstruction has issues with patient compliance, skin-related complications and fat necrosis, which may limit its applicability,” the researchers said.

“Women who undergo external expansion and AFG can attain improvements in QoL compared to baseline, but the gains in QoL are likely to be less … than for conventional reconstruction,” they added.