Total Breast Reconstruction with Autologous Fat Transfer: Review of a Seven-Year Multicenter Experience

Autologous Fat transfer (AFT) is now widely accepted as an adjunct to traditional methods of breast reconstruction. However, AFT's ability to reconstruct an entire breast is still not firmly established. We hereby present our seven-year, multicenter experience with total breast reconstruction using solely AFT and external expansion.

We performed 1,877 AFT procedures on 616 breasts in 488 women (44% radiated) to reconstruct 99 lumpectomies, 87 immediate and 430 delayed total breast reconstructions. After 2-4 weeks of Brava treatment, which increased pre-expansion volume by 100-300%, we diffusely injected the breasts with 100–400 ml (225 ml average) of micro-droplets of 15G sedimented, manually harvested lipoaspirate. The procedure was repeated every 8–14 weeks as needed till completion of the reconstruction.

Follow up ranges from six months to seven years (mean, 2.5 years). 427 women completed the reconstruction while 12.5% dropped out (2.5% medical, 10% personal reasons). Final breast reconstructed volume was 375 ml (150–900). Completing the reconstruction required 2.0, 2.1, 2.8, 4.2, and 4.9 procedures/breast for lumpectomy, nonradiated immediate, nonradiated delayed, radiated immediate, and radiated delayed mastectomies, respectively. 97% were satisfied with the volume, shape, and feel of their breasts as they recovered near-normal sensation over the entire mound. 37% of the radiated and 12% of the nonradiated reconstructions had palpable masses, none of which required open biopsy. Complications included 5 (0.8%) pneumothoraces, 15 (2.4%) abscesses/ulcerations in the radiated and 3 (0.5%) abscesses/ulcerations in the nonradiated breasts. The immediate nonradiated had the best results, while the immediate radiated had the highest complications. One mastectomy (0.2%) and two lumpectomies (2.0%) had local recurrence.

AFT + Brava is a minimally invasive, safe, and effective alternative for breast reconstruction. The procedure is outpatient, involves no incision, has minimal complications, and a very high level of patient satisfaction.