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American Association of Plastic Surgeons

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Autologous Breast Augmentation With Incision Free Flaps: Experience With 120 Consecutive Cases
Roger K. Khouri, MD, Raul Cortes, MD, Daniel Calva, MD.
Miami Breast Center, Key Biscayne, FL, USA.

Breast augmentations with autologous fat grafting are limited by the amount of tissue that can be reliably transferred as avascular grafts. Vascularized flaps, on the other hand, dependably transfer much more tissue. To supplement AFT breast augmentations with vascularized flaps, we developed an incision-free technique to percutaneously dissect, transfer to the breast, and secure in place lateral thoracic and reverse abdominoplasty flaps. This is a report of our 8-years experience with 120autologous incision free flaps breast augmentations.
METHODS: To mobilize the flap, we thread a #2PDS purse-string all-around the breast from the infra-clavicle, to the sternum, to 2-5cm caudal to the infra-mammary fold, to the mid-axillary line till the end of the lateral-mammary fold. While maintaining tension on the suture, with windshield motions of a long cutting needle we percutaneously dissect the flap and undermine the peripheral tissues to completely relieve the tension. The suture is then tied and suspended to the clavi-pectoral fascia.
RESULTS:
These incision free flaps reliably transferred a crescent of peri-mammary skin and 100-250ml of flap tissue to mushroom up satisfactory breast mounds and define new mammary folds. Late follow-ups did not differ much from the intra-operative result because flap tissue transfers are volume stable. Early failures were premature suture dehiscence and minor fold necrosis from excessive undermining.
CONCLUSION:
Fat transfer+incision free flap is a reliable method of autologous breast augmentation.


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