The force required to support the weight of a woman’s breasts is focused almost entirely at the upper ridge of the shoulder, under the brassiere strap. The “bra strap defect” develops as a conspicuous depression in the soft tissue due to constant weight-bearing tension over several years, or in association with breast hyperplasia. We introduce the use of fat transfer as a fast, practical, and simple method to correct this deformity.
Autologous fat transplantation has proven to be beneficial, has revolutionized the scope and practice of soft-tissue augmentation, and has advanced considerably since it was first developed more than a century ago. However, differing methods of harvest and transplantation assert subtle but important effects on viability.1,2 Negative pressure in the syringe is distributed to cell membranes during extraction; the use of −700 mmHg of vacuum pressure has been shown to result in membrane rupture and vaporization of fat cells.3 Refined fat parcels must be delivered to the recipient site atraumatically, survive predictably and uniformly, and integrate with host tissue to accomplish the desired structural alteration.1–5 Improved harvesting, handling, and centrifugation techniques can make successful resolution of this and other contour defects possible.
Five patients ranging in age from 36 to 59 years with moderate to severe shoulder grooves (0.5 to 3.0 cm deep) have been treated since September of 2004. The defect and harvest sites are marked preoperatively. The supraumbilical region is our preferred site for fat removal. After regional infiltration with Klein tumescent solution, syringe liposuction is performed using a 10-cc syringe with a cobra-tipped blunt cannula. Mild suction is applied (<0.5 atm) to aspirate approximately 45 cc of tissue.
After centrifugation, a blunt-tipped Coleman cannula is introduced to inject fat into the shoulder deformity. Approximately 20 cc of fat is required for each side. The retroinjection technique provides gentle, atraumatic delivery of cells to the desired area. Layering the tunnels in a deep-to-superficial, crisscross pattern reduces irregularity and provides the smoothest results. We recommend 20 to 40 percent overcorrection to compensate for fat reabsorption.
The puncture incision is left open for drainage, and compression gauze is placed over the wound. The patient wears a sports or strapless bra for 2 months and avoids using heavy purses or backpacks that put pressure on the recipient sites (Fig. 1).
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Fig. 1.:
(Above) Bra strap deformity with pronounced defect forming a distinct crevice approximately 3 cm deep. (Below) One-month postoperative view, with resolution of the deformity.
Potential complications include unevenness, distortion, overcorrection, infection, and undergrafting. Intraoperative overcorrection of 30 percent should be performed to compensate for the inevitable volume loss, in order to reduce the need for additional grafting sessions.
Shoulders permanently indented from years of bra strap tension may be easily repaired in a single 30-minute fat-grafting session. Free fat transfer is a fast, practical, and easy way to restore a harmonious contour to the midshoulder region. At the present time, we believe this is the first publication to report on the use of autologous fat transfer for the reconstruction of the bra strap shoulder defect.
DISCLOSURE
No author affiliated with this study received grants, funding, or reimbursements.
Henry A. Mentz, M.D.
Department of Plastic Surgery
Baylor College of Medicine
St. Joseph Hospital Residency Training Program
Houston, Texas
Amado Ruiz-Razura, M.D.
Division of Plastic and Reconstructive Surgery
University of Texas Medical School at Houston
Aesthetic Center for Plastic Surgery
Houston, Texas
Laura A. Miniel, B.A.
University of Texas Medical Branch
School of Medicine
Galveston, Texas
REFERENCES
1. Markey, A. C., and Glogau, R. G. Autologous fat grafting: Comparison of techniques.
Dermatol. Surg. 26: 1135, 2000.
2. Fulton, J. E., and Parastouk, N. Fat grafting.
Dermatol. Clin. 19: 523, 2001.
3. Shiffman, M. A., and Mirrafati, S. Fat transfer techniques: The effect of harvest and transfer methods on adipocyte viability and review of the literature.
Dermatol. Surg. 27: 819, 2001.
4. Coleman, S. R. Structural fat grafts: The ideal filler?
Clin. Plast. Surg. 28: 111, 2001.
5. Mentz, H., Ruiz-Razura, A., Patronella, C., et al. Indications for fat grafting in plastic surgery.
Plastic Surgery Products June: 32, 2005.
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