Reconstruction with implants allows for a quick volume and shape restoration but at the expense of different consistencies.1,2,9,10
Reconstruction with fat grafting in conjunction with the BRAVA system became popular in recent years; however, the use of the external expansion is burdensome and requires strong motivation.3,5 Although concerns exist regarding graft viability, especially in patients after radiotherapy,16,17 some reports demonstrated good fat viability in poorly vascularized areas.18
This type of clinical experience has been the inspiration to use fat grafting combined with internal expansion for breast reconstruction. Injecting fat directly after reducing the expander’s pressure on the recipient site is conducive to its integration, as was the case in the experimental study.18,19 In contrast to fat grafting augmented with the BRAVA system, this protocol is less demanding for the patient. Rapid restoration of breast volume after implantation of the expander and subsequent gradual change of the breast consistency and shape encourage return to professional and intimate life seem to motivate the patient to continue the treatment.
Although we demonstrated successful breast reconstruction using this method, due to lack of data from the literature, we cannot equivocally determine possible benefits and risks of this protocol.
After appropriate preparation, the method can be used by surgeons experienced in fat grafting under standard conditions. In combination with further studies on fat tissue physiology, this may be a promising direction in breast reconstruction.
This study demonstrated a successful breast reconstruction using fat grafting and expander implantation. This simple, inexpensive technique does not require microsurgical skills. It allows restoring natural breast consistency and volume with minimal scarring. Although this protocol may be an interesting alternative for many patients, subsequent studies are needed to verify all potential benefits and complications.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
1. Hammond DC, Schmitt WP, O’Connor EA. Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg. 2015;135:15401544.
2. Sigalove S, Maxwell GP, Sigalove NM, et al. Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results. Plast Reconstr Surg. 2017;139:287294.
3. Khouri RK, Rogotti G, Cardoso E, et al. Megavolume autologous fat transfer: part 1. Theory and principles. Plast Reconstr Surg.2015;133:550557.
4. Knox AD, Ho AL, Leung L, et al. Comparison of outcomes following autologous breast reconstruction using the DIEP and pedicled TRAM flaps: a 12-year clinical retrospective study and literature review. Plast Reconstr Surg.2016;138:1628.
5. Khouri RK, Eisenmann-Klein M, Cardoso E, et al. Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg. 2012;129:11731187.
6. Stillaert FB, Sommeling C, D’Arpa S, et al. Intratissular expansion-mediated, serial fat grafting: a step-by-step working algorithm to achieve 3D biological harmony in autologous breast reconstruction. J Plast Reconstr Aesthet Surg. 2016;69:15791587.
7. Manconi A, De Lorenzi F, Chahuan B, et al. Total breast reconstruction with fat grafting after internal expansion and expander removal. Ann Plast Surg. 2017;78:392396.
8. Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg. 2006;118(3 Suppl):108S120S.
9. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345353.
10. Spear SL, Pelletiere CV. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants. Plast Reconstr Surg. 2004;113:20982103.
11. Sommeling CE, Van Landuyt K, Depypere H, et al. Composite breast reconstruction: implant-based breast reconstruction with adjunctive lipofilling. J Plast Reconstr Aesthet Surg. 2017;70:10511058. doi:10.1016/j.bjps.2017.05.019.
12. Kanchwala SK, Glatt BS, Conant EF, et al. Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities. Plast Reconstr Surg. 2009;124:409418.
13. Muresan H, Lam G, Cooper BT, et al. Impact of evolving radiation therapy techniques on implant-based breast reconstruction. Plast Reconstr Surg. 2017;139:1232e1239e.
14. Unger JG, Carreras JM, Nagarkar P, et al. Allergan style 410 implants for breast reconstruction: a prospective study in efficacy, safety, and symmetry. Plast Reconstr Surg. 2016;138:548555.
15. Selber JC, Nelson J, Fosnot J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: part I. unilateral reconstruction. Plast Reconstr Surg. 2010;126:11421153.
16. Delay E, Garson S, Tousson G, et al. Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J. 2009;29:360376.
17. Hamza A, Lohsiriwat V, Rietjens M. Lipofilling in breast cancer surgery. Gland Surg. 2013;2:714.
18. Gassman AA, Lewis MS, Lee JC. Remote ischemic preconditioning recipient tissues improves the viability of murine fat transfer. Plast Reconstr Surg. 2016;138:55e63e.
19. Doi K, Ogata F, Eto H, et al. Differential contributions of graft-derived and host-derived cells in tissue regeneration/remodeling after fat grafting. Plast Reconstr Surg. 2015;135:16071617.