INTRODUCTION: The force required to support the weight of a woman's breast is focused almost entirely at the upper ridge of the shoulder under the brassiere strap. These soft tissue defects develop as a conspicuous depression due to the constant weight bearing tension over several years or in association with breast hyperplasia.

OBJECTIVE: We introduce a fast, simple and practical method to correct brassiere strap soft tissue defects with the use of autologous fat transfer. Present the methodology and clinical results after a two year follow up.

MATERIALS AND METHODS: Fifteen patients ranging from 36-59 years of age with moderate to severe shoulder groove deformities ranging from 0.5 to 3.0 cms in depth have been treated since September 2004. The supraumbilical area was the preferred site for fat harvesting. After regional infiltration with tumescent solution, suction aspiration was performed using a 10cc syringe with a cobra tipped blunt cannula to aspirate 45cc of fat. Following centrifugation, a blunt-tipped Coleman cannula was introduced to inject fat into the shoulder deformity. Approximately 20 cc of fat were required for each side. A retro-injection technique was used to allow a gentle, atraumatic delivery of fat cells into the soft tissue deformity. Layering the tunnels in a deep-to-superficial, criss-cross pattern, reduced irregularity and provided the smoothest result. We allowed a 30-40% overcorrection of the defect to compensate for fat re-absorption. Puncture incision sites were left open for drainage and a compression gauze was placed over the wound. Patient wore a sports-type strapless brassiere for 2 months, avoiding heavy shoulder purses or backpacks that exert pressure on the fat grafted sites.

RESULTS: All 15 patients have tolerated the procedure well without any discomfort or complications. There has been a 25-30% fat absorption rate in the defects. However, none of the patients have required a second fat grafting session. The follow up control ranges from 3 to 24 months post operative. Photographic documentation demonstrates why patients are very pleased with the results.

CONCLUSION: Autologous fat transfer to reconstruct the bra strap deformities has proven to be a fast, practical and simple procedure to restore harmonious contour to the mid shoulder region. Allowing a 30% of overcorrection of the defects for the inevitable fat absorption has proven to be beneficial. At the present time, we believe this is the first report of the use of this technique to repair brap strap deformities.

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