Total breast reconstruction using large-volume condensed and viable fat grafting after mastectomy

Abstract

Autologous fat grafting (AFG) has become a third alternative for breast reconstruction after mastectomy. However, total breast reconstruction using AFG remains a great challenge. We performed breast reconstruction using large-volume condensed and viable fat grafting in 30 postmastectomy patients (irradiated, n = 9; nonirradiated, n = 21). The grafts were purified and condensed by the washing and cotton gauze rolling technique. The surgical maneuver is designed to preserve the grafts viability. Three-dimensional expansion was applied where strong adhesions were present. Seven patients wore the Brava device for the expansion of the recipient site. The mean (SD) volume of fat grafted in each procedure was 230.5 (57.8) mL. The average number of sessions was 3.3 (0.7). The irradiated patients required more sessions than the nonirradiated patients (p=.017). The mean follow-up period was 12.8 (4.3) months. One patient (3%) developed postoperative cellulitis. Cysts and palpable nodules occurred in eight patients (27%) and one patient (3%), respectively. Severe dermatitis and skin pigmentation change occurred in one patient wearing the Brava device. The esthetic scores significantly improved after the treatments (p<.001). Approximately 90% of the patients were satisfied. No local recurrence or remote metastasis was documented during the follow-up period. Our study showed the success of total breast reconstruction using AFG. As a third alternative for breast reconstruction, total breast reconstruction using large volume condensed and viable fat grafting is an effective and safe approach for postmastectomy patients.