Abstract: 10.30 Intratissular Expansion And Layered Fat Grafting In Autologous Breast Reconstruction

Abstract

INTRODUCTION: Breast reconstruction involves the use of autologous tissue or implants. However, fat grafting seems the ideal technique because of its minimally invasive character but the challenge is to reconstruct a 3D, homeostatic tissue construct using a liquefied tissue (lipoaspirate) as building blocks. MATERIALS AND METHODS: Total breast reconstruction (n=7) was performed with intratissular expansion and serial lipofilling sessions. Mean age of the patients was 41 years old (22–53). A prepectoral positioned expander created skin expansion and induced the formation of a peri-prosthetic capsule with boundary conditions between the outer skin envelope and the well-vascularized capsule. The vascular plexus in the outer layer of the capsule functioned as a vascular source. Serial deflation and fat grafting sessions were initiated at 8 weeks with an interval of three months until the desired volume was obtained. The expander was removed during the last session. The fat grafting procedure consisted of manual liposuction and processing following the Coleman protocol. An average of 644cc (range 415 _ 950cc) of lipoaspirate material was injected to reconstruct the breast with an average of 4 (range 3–5) fat grafting sessions. Average follow-up was 14 months (range 9–29 months). RESULTS: All patients completed the treatment successfully with a pleasing, stable, prepectoral breast reconstruction. Magnetic resonance imaging examination showed a mean breast volume of 378cc (range 218 _ 557cc) and retained no tissue necrosis. One infection occurred which necessitated temporary removal of the expander. There were no adverse effects related to the lipofilling procedures. CONCLUSIONS: In a selected group of patients we have been able to reconstruct an aesthetically pleasant and stable breast mound with intratissular expansion and fat grafting with rather predictable results. Further refinements include the incorporation of a nutritional matrix to enhance the survival rate of fat grafts and reduce the number of fat graft sessions.