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Reclaiming The Wastelands: Fat Grafting Before Autologous Breast Reconstruction
Elizabeth Elaine Bushong, MD1, Liselle Tungol, BS
2, Ewa Komorowska-Timek, MD, FACS
3.
1Corewell Health- Grand Rapids Integrated Plastic Surgery Residency, Grand Rapids, MI, USA, 2Michigan State Unveristy College of Human Medicine, East Lansing, MI, USA, 3Advanced Plastic Surgery, Grand Rapids, MI, USA.
Purpose: Autologous tissue transfer for radiated breast reconstruction frequently requires excision of mastectomy skin to eliminate potential constriction, resulting in “patched” and aesthetically inferior appearances. We present a novel approach to salvage and revitalize radiated mastectomy skin prior to microsurgical breast reconstruction.
Methods: Retrospective analysis of patients who underwent breast reconstruction with deep inferior epigastric perforator (DIEP) preceded by fat grafting to radiated mastectomy skin flaps. The mastectomy skin (with or without nipple) used for reconstruction were compared. Peri-operative complications were noted.
Results: The series includes six radiated breasts in six patients ages 54.5 ± 5.2 years and BMI 25 ± 2.1 with follow up 2.6 ± 2.48 years. Five breasts had tissue expanders removed prior due to infection, capsular contracture, or radiation-induced implant exposure. Only one TE was present at fat grafting and microsurgery. All patients received fat grafting (211cc ± 77cc) to the mastectomy flap 217 ± 171 days after completing radiation therapy and 250 ± 114 days prior to free-flap. Three patients experienced minor fat necrosis that resolved. During free flap transfer, all available mastectomy skin and nipples were salvaged. Figure 1 demonstrates an exemplary patient (A) after 250 cc of fat grafting (B) followed by bilateral DIEP flaps (C).
Conclusion: Fat grafting prior to autologous tissue transfer can salvage mastectomy skin and yield aesthetically superior results with low complications.
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