|2009 Annual Meeting Abstracts
Minimally Invasive Autologous Mastectomy Incisionless Reconstruction; External Expansion Fat Grafting and Percutaneous Scar Release: A Multicenter Experience.
Gino Rigotti, M.D.1, Alessandra Marchi, MD1, Roger K. Khouri, MD, S2.
1Azienda Ospedaliera Verona-Italy, Verona, Italy, 2Miami Plastic and Reconstructive Surgery, Miami, FL, USA.
We developed a more patient friendly alternative method of autlogous breast reconstruction and hereby report our combined multicenter experience. though involves significant surgery and morbidity. e 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.
Twenty one women with total mastectomies were enrolled (29 breasts). The time from mastectomy to reconstruction ranged from immediate to 30 years. Eight (?) women had post-operative irradiation. The external expander was applied 10 hours per day for 10 to 30 days prior to the first grafting session. Expansion was considered adequate when the mastectomy skin envelope expanded to create an additional 200 - 300 ml of extracellular recipient matrix. Lipografting was performed on an outpatient setting, often under local anesthesia with sedation. Tethering scars were released percutaneously with a needle band technique. One week post-transfer, they resumed use of the expander for 10 hours per day till the next lipografting session. The procedures were spaced 6- 12 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.
Depending upon the volume of the recipient space, 100 to 500 ml of fat suspension were grafted per breast per grafting session. Two to four outpatient procedures were required to achieve a satisfactory reconstruction for the non-radiated defects and four to six if previously irradiated. Six months after the last graft, 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.
We describe a paradigm shift in breast reconstruction. By combining serial lipografting with external expansion we achieved, with a 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.