BEAUTY and the DIEP: Improved Aesthetic Results with Autologous Fat Grafting to the Reconstructed Breast

Introduction:  Breast reconstruction after mastectomy has changed dramatically over the last decade.   With improvements in surgical technique and technology, both the expectation of the patients and surgeons has expanded to include not simply an acceptable reconstructed breast mound, but also a superior aesthetic result. The use of autologous fat has gained popularity since the early 1980s with its success in aesthetic and reconstructive applications to the face.  Previously, secondary procedures such as mastopexy and liposuction were viewed as the only options to ensure symmetry and assist in providing a natural contour however, currently autologous fat grafting (AFG) is being used in contouring of the reconstructed breast.  The safety of autologous fat grafting has already been demonstrated.  Currently, many are evaluating its usefulness and application in providing an improved aesthetic result after free flap breast reconstruction.

This study was designed to add to the growing literature of successful autologous fat grafting to the reconstructed breast and to demonstrate that autologous fat grafting allows for a better aesthetic result when used during second stage breast reconstruction after free flap reconstruction.

Methods:  This is a retrospective review of 100 consecutive patient treated with autologous fat grafting after previous perforator flap reconstruction from August 2009 to August 2011 by one senior surgeon.  All patients underwent free flap reconstruction with DIEP, TUG, PAP or SGAP flap after either skin sparing mastectomy or modified radical mastectomy, followed by autologous fat grafting.  Follow up was twelve months.  Clinical and photographic assessments of post-operative results were reviewed. Parameters assessed included symmetry, projection and overall aesthetic result as well as patient satisfaction.

Results:  All patients had improved aesthetic results based upon symmetry, projection and patient satisfaction. 

Conclusion:  The improved aesthetic result provided by autologous fat grafting cannot be achieved with other surgical adjuncts.  AFG allows the reconstructed breast to have a more natural appearance particularly assisting in providing adequate size and projection.  The ease of procurement and transfer causes AFG to be the ideal adjunct for ensuring a superior aesthetic result in the reconstructed breast.