Improved Cosmetic Outcomes with Free Fat Transfer in Breast Implant Reconstruction:  A Review of 42 Procedures in 21 Patients

 Introduction: Reconstruction of the postmastectomy breast with two stage biodimensional expanders and implants yields excellent results in most patients.  However, disfiguring tissue contour deformities can result.  Most common is  thin tissue coverage superior to the implant reconstruction (superior perimeter defect) and wrinkling of the implant.  The purpose of this study is to review our experience with treatment of these deformities using the "Coleman" free fat transfer system.

 Methods:  A retrospective review was undertaken of 21 patients with tissue contour deformities after two stage breast reconstruction with biodimensional expanders and implants. These deformities were corrected by free fat transfer using the Coleman system.  All reconstructions and fat transfers were performed by a single surgeon.

 Results:  21 patients underwent 42 procedures to correct post implant contour deformities 2003-2008.  The average age was 52 years (range 25-71 years).  Thirteen  patients (62%)underwent bilateral fat transfers. Seven patients (33%)underwent a second fat transfer procedure.  The average interval from implant placement to fat transfer was 9.9 months (range 2-44 months).  The averge interval between the repeat fat transfer was 8.5 months.  The indications for fat transfer was superior perimeter defects in 14 patients(67%);  implant wrinkling and superior perimeter defects in 6 patients (29%); and contour deformity in 3 patients (14%). Four patient underwent simultaneous implant replacement for breast asymmetry. All procedures were performed in an outpatient surgery center under general anesthesia.  The amount of fat transferred averaged 67 cc per breast (range 30-180cc).  The fat was harvested from the abdomen in all cases.  In 2 patients additional fat was harvested from the upper thighs.  There were no reports of postop cellulitis or obvious fat necrosis.  Four patients required a second fat transfer due to initial under correction.

 Conclusions: Free fat transfer is a safe and effective means of correcting bothersome tissue contour deformities following postmastectomy implant reconstruction.