Immediate breast reconstruction by exclusive autologous fat grafting after prophylactic mastectomy: A quantitative and qualitative study.

INTRODUCTION: Breast cancer is strongly associated with inherited pathogenic variants, particularly BRCA mutations. Risk-reducing mastectomy is a common preventive strategy among mutation carriers, and breast reconstruction is known to improve quality of life after mastectomy. Conventional techniques, including implant-based and flap reconstruction, are widely used but are associated with limitations and complications. Although autologous fat grafting (AFT) is widely used in breast reconstruction, evidence supporting its use as the sole reconstructive technique following immediate prophylactic mastectomy is limited.

METHODS: We conducted a monocentric descriptive study of patients with BRCA or related mutations who underwent prophylactic mastectomy, followed by immediate breast reconstruction (IBR) with exclusive AFT. The outcomes included patient satisfaction, assessed using the BREAST-Q at 3 months after the end of the reconstruction, and the feasibility and safety of AFT.

RESULTS: The mean number of AFT sessions was 5.3 per breast. The average reconstruction duration was 23.3 months, with a mean injected volume of 813 mL. High satisfaction was reported, with mean scores of 8.4/10 for the reconstruction technique and 7.1/10 for esthetic results. The BREAST-Q scores were comparable to patients with BRCA after prophylactic mastectomy and IBR with conventional techniques. Complications of lipofilling were uncommon, with major complication rate of 2.6%.

CONCLUSION: Exclusive AFT appears to be a safe and feasible technique for IBR after prophylactic mastectomy in BRCA mutation carriers. It offers good patient satisfaction and low complication rates and may represent a valuable option for appropriate candidates. Results should be interpreted in light of the single-center setting and inclusion of completed reconstructions alone.