Total breast reconstruction with lipofilling after traditional mastectomy without the use of tissue expanders.

BACKGROUND: Lipofilling can be used to reconstruct a breast without additional implants or autologous composite grafts. However, methods to maximize retention of the transferred fat remain under debate. Here we present our experience of breast reconstruction with lipofilling without concomitant use of tissue expanders.

METHODS: Patients who had completed breast reconstruction with lipofilling between June 2010 and June 2016 were reviewed. Those with obtainable follow-up MRI imaging were included in this cross-sectional study. The hospital records were reviewed for details of the lipofilling operations. MRI images were evaluated for the volume retention and quality of the transferred fat. The patients were asked to assess the appearance and sensitivity of the reconstructed breast, the recovery time, and any adverse effects at the fat donor area.

RESULTS: 38 women with 41 reconstructed breasts were included in the study. The median age at follow-up was 62 (range 48-78). They had undergone a median 4 (2-6) lipofilling procedures with a median total volume 690 (369-1350)ml. After a median 2.1 (0.4-6.8) year follow-up, the median proportion of transferred fat retained was 58 (14-119)%, representing reconstructed breast volume 76 (17-100)% of the contralateral breast. Oil cysts larger than 10mm were detected in 7%. Most patients reported being satisfied with the reconstructed breast and experienced few side effects.

CONCLUSIONS: Breast reconstruction with lipofilling can be performed with an acceptable number of procedures and no preoperative skin expansion. It extends the option of autologous breast reconstruction to women unsuitable for major reconstructive procedures.