D152. Total Breast Reconstruction with Autologous Fat Transfer (AFT) And Reverse Expansion (ER): Experience with 2000 AFT-ER Breasts

Abstract

PURPOSE: Autologous reconstructions provide long-term patient satisfaction but are in-patient invasive procedures with morbidities and complications. AFT alone reconstructions are limited because fat is not an expander. Pre-expansion of the mastectomy followed by AFT to the laxity created by RE solves this limitation. METHODS: For immediate reconstructions, we insert subpectoral expanders and graft 150-200ml as fat ribbons teased in-between the exposed muscle fibers. After adequate post-operative expansion, we remove the expander, graft the laxity with 250-350ml of fat, and preserve the breast mound by inserting an implant half the expander size. To convert the implant reconstructed breasts to autologous fat, we remove the implant, replace it with a 50% smaller one and graft the loosened tissues. In both situations we repeat the procedure every three months till the patient is implant free. RESULTS: We reviewed our past 2000 consecutive AFT-ER out-patient breasts reconstructions. Non-radiated mastectomies required 3.2 sessions. At each session, the expanded breast volume remained constant as the intervening mastectomy tissue thickness doubled while the implant volume halved. Radiated breasts took 5.8 sessions, with less grafting per session and less than halving implant size. Patient satisfaction was very high, especially in previously implant reconstructed patients converted to fat. Complications were minimal, more frequent in the radiated breasts and mostly due to overgrafting or excessive scar release in cases with previous complications. CONCLUSION: AFT-ER is a safe and highly satisfying autologous breast reconstruction alternative with no donor site defect and liposuction bonus. The multiple procedures are minimally invasive and out-patient.