Total Breast Reconstruction With Reverse Expansion (RE) And Autologous Fat Transfer (AFT): Single Center Experience With 2000 Breasts
Roger K. Khouri, MD1, Daniel Calva-Cerqueira, MD2, Raul A. Cortes, MD2.
1Miami Breast Center, Key Biscayne, FL, USA, 2Miami Breast Center, Miami, FL, USA.
Autologous breast reconstructions provide long-term patient satisfaction but flaps are in-patient invasive procedures with morbidities and potential complications. Less invasive AFT reconstructions stall because fat is not an expander. This may be solved by pre-expansion of the mastectomy followed by AFT to the de-expanded recipient laxity.
For the immediate reconstructions, we insert subpectoral expanders and graft 150-200ml as individual fat ribbons teased in-between the exposed muscle fibers. After adequate post-operative expansion, we remove the expander and graft the expanded tissues with 200-400ml of fat and restore the breast mound by inserting an implant half the expander volume. To convert the already-expanded implant reconstructed breasts to autologous fat, we remove the implant, replace it with a 50% smaller one and graft the loosened tissues. In both situations we repeat the procedure every three months till the patient is implant free.
We reviewed 2000 consecutive breasts reconstructions with RE and AFT performed in our ASC. Non-radiated mastectomies required 3.2 sessions. At each session, the expanded breast volume remained constant as the intervening mastectomy tissue volume doubled while the implant volume halved. Radiated breasts took 5.8 sessions, with less grafting and less than halving implant size per session. Patient satisfaction was very high, especially in implant to fat converted patients. Complications were minimal, more frequent in the radiated breasts and mostly due to overgrafting or excessive scar release in previously complicated reconstructions.
Despite our extensive experience with flaps, RE and AFT is now our favorite breast reconstruction method. Patients like it best.
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