L. Fabiocchi , G. Semprini , F. Cattin , L. Dellachiesa , T. Fogacci , G. Frisoni , D. Samorani
Breast Unit Rimini - AUSL della Romagna
The majority of surgeons choose an implant-based breast reconstruction after mastectomy (1). Nevertheless, lipofilling is a constantly growing technique allowing a complete breast reconstruction without prosthesis. We introduce our experience using reverse expansion for breast reconstruction following a nipple-sparing mastectomy with a breast expander and a human derived acellular dermal matrix insertion.
In 2010, we began to perform fat grafting for breast reconstruction using the "Reverse Expansion" technique (2). In the period January 2010 - December 2017, 80 breast reconstruction procedures were performed on 33 patients. The technique consists of autologous fat tissue transplantation requiring the combined use of a skin expander and of multiple lipofilling sessions.We harvested an amount of fat tissue using a 2.5 mm liposuction cannula, we centrifuged it 3 minutes at 4000 rpm and injected in the recipient site using 3 ml syringes and a Coleman cannula. At the beginning of every session the breast expander was deflated of a saline volume similar to the one of the fat to be injected. Skin expander deflation is used to achieve a good breast volume without significative pressure during fat grafting
We harvested an average of 654.9 ccs of fat per session and injected an average of 324.07 ccs. The mean number of sessions has been 2.4. The average number of sessions in a radiotreated patients subgroup has been slightly higher than a control group. The mean hospitalization time was two days. The mean follow up time is 32.5 months and we saw no complications in 77 over 80 procedures.
Lipofilling has proven to be a safe and effective technique for complete breast reconstruction. Our procedure considers the use of a breast expander as a device to prepare the recipient site. Reverse expansion after a nipple sparing mastectomy allows a like-to-like reconstruction and it might be the first reconstructive choice in a selected group of patients.
Considering the large number of positive factors such as: fast post-operative recovery, easy learning curve and no need of a specialized surgical team, natural look of the breast shape, soft consistency of the grafted tissue, we believe that this method of breast reconstruction with autologous tissue could be considered as a new autologous reconstruction possibility after NSM.
1. American Society of Plastic Surgeons. 2014 Statistics. Available at: http://www.plasticsurgery.org/Documents/news-resources/statistics/2014-statistics/plastic-surgery-statsitics-full-report.pdf. Accessed October 1, 2015.
2. L. Fabiocchi , G. Semprini , F. Cattin , L. Dellachiesa , T. Fogacci , G. Frisoni , D. Samorani. Reverse expansion: A new technique of breast reconstruction with autologous tissue. Journal of Plastic, Reconstructive & Aesthetic Surgery (2017) 70, 1537e1542