AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Minimally Invasive Autologous Total Breast Reconstruction by External Expansion and Serial Lipografting: A preliminary Experience.
Roger khouri, MD.
Miami Plastic surgery Center, Key Biscayne, FL, USA.

Purpose: To explore the feasibility of engineering a breast mound, we combined external expansion to stretch the mastectomy scar and generate a vascularized scaffold with serial lipografting to seed the created recipient matrix with live tissue.
Method: Six women with bilateral total mastectomies were enrolled (12 breasts). The time from mastectomy to reconstruction ranged from immediate to 30 years. Three women had post-operative irradiation. They were all asked to use the external expander for at least 10 hours per day (usually sleep with it at night) for 10 to 30 days prior to the first grafting session. Expansion was considered adequate when the mastectomy scars stretched to create an additional 200 - 300 ml of extracellular recipient matrix. Lipografting was performed on an outpatient setting, often under local anesthesia. One week post-transfer, they resumed use of the expander for 10 hours per day till the next lipografting session. The procedures were spaced 4- 8 weeks apart and repeated till the surgeon and the patient were satisfied with the breast volume and shape. Follow up MRI and mammograms were obtained.
Results: Depending upon the volume of the recipient space, 150 to 600 ml of fat suspension were grafted per breast per grafting session. Two to four outpatient procedures were required to achieve a satisfactory reconstruction. Six months later, final stable breast volume ranged from 300 ml to 600 ml. The breasts were soft, sensate, and had aesthetically pleasing shapes. Mammographies were read as normal fatty breasts and MRI revealed well vascularized fat with a few scattered benign oil cysts. Complications included a swiftly treated pneumothorax and a few transient cysts. All patients were satisfied with their reconstructed breasts and thankful for the body sculpturing byproduct. No new scars were added and the original mastectomy scars were markedly improved.
Conclusion: We describe a paradigm shift in breast reconstruction. By combining serial lipografting with external expansion we achieved, with very few minimally invasive grafting procedures, the equivalent of an autologous flap breast reconstruction. External expansion increased the size of the recipient matrix to allow better dispersion of a much larger volume of fat micrografts, better graft to recipient interface and improved graft survival. It also allowed us to bluntly release the tight scars and diffusely fill their mesentery with micrografts, avoiding the sharp dissection that leads to large cavities with poor survival of the pooled graft. This method of breast reconstruction has promise.


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