Composite breast reconstruction: Implant-based breast reconstruction with adjunctive lipofilling

Abstract

Options for breast reconstructions enclose autologous tissue transfers or implants. Fat grafting is gaining more interest in this specific field of breast surgery. This study concentrates on the technique and aesthetic results of breast reconstruction with fat grafts combined with implants, in women who have undergone total mastectomy. Breast reconstructions (n=23) was performed using a protocol of intratissular expansion with serial deflation-lipofilling. In order to achieve the best aesthetic outcome, an additional small implant was placed. A retrospective data analysis was performed. In all patients a tissue expander was placed at the time of mastectomy or after removal of a previous breast reconstruction. The mean of lipoaspirate material for the reconstruction was 333mL (range 120-715mL). To create an adequate volume of the reconstructed breast, a supplementary small implant was placed, with a mean volume of 222mL (range 125-375mL). The mean follow-up was 33 months (range 19-50 months). A MRI analysis was performed in eight patients at least 9 months after the last lipofilling procedure, demonstrating a mean of 171mL (range 64-538mL) of transferred fat, a mean fat survival of 53% and a volume ratio of fat graft/implant of 0.97 (range 0,3-3,8). This composite technique of using autologous fat tissue and implants shows aesthetic pleasant results and must be considered as a valid alternative in a subset of patients. Further investigations to optimize the fat graft take must be encouraged.