Breast reconstruction with fat grafting and BRAVA(®) pre-expansion: Efficacy evaluation in 45 cases.

INTRODUCTION: Fat grafting for breast surgery, in reconstruction or aesthetics, gained a lot of popularity over the last years. As an addition to breast reconstruction with flaps or prosthesis, lipofilling improved the aesthetic result, increasing the patients' satisfaction rate. The demand for breast reconstruction using only fat grafting increased, because patients want a natural result in breast reconstruction and also the body contouring associated with liposuction of specified fat areas. The pre-expansion BRAVA(®) system has been used for several years in the United States to prepare the receiving site for lipofilling. We wanted to gain our own experience in associating BRAVA-lipofilling in breast reconstruction. The aim of our study is to evaluate the BRAVA efficiency as an adjuvant for fat grafting in breast surgery. MATERIAL AND METHODS: A retrospective study was undertaken, using a homogenous series of consecutive patients, operated by one surgeon (the first author), that had breast reconstruction using only fat grafts associated with BRAVA(®). RESULTS: The retrospective homogenous study identified 45 cases of breast surgery associating fat grafting alone with BRAVA(®) assistance. The number of intervention of fat grafting associating BRAVA(®) was 1 or 2 for conservative treatment sequelae or for flap reconstruction improvement, and 2 to 4 for immediate and delayed breast reconstruction. The total volume of fat grafting was 205 cc for the contralateral balancing, 317 cc for flap reconstructions, 531 cc for the conservative treatment sequelae, 790 cc for the immediate breast reconstruction and 1165 cc for the delayed breast reconstruction. The satisfaction rate of the surgical team and the patients was satisfying and very satisfied in 82% of cases, average in 8% of cases, and insufficient in 10% of cases. CONCLUSIONS: Breast reconstruction with fat grafting alone is, in our experience, a reliable and reproducible technique, that gives excellent and stable results. The high satisfaction rate of patients is explained by the supple and natural consistency of the new breast, with no added scars, associating the benefits of liposuction of the donor sites. The BRAVA(®) system seems to be, in cases with good indications, an adjuvant for receiving site preparation, making the reconstruction easier for the surgeon and for the patient. We believe that breast reconstruction with fat grafting alone is going to become more popular in the future. Associating fat grafting with BRAVA(®) creates a new way of natural breast reconstruction for the patients with mastectomy that want a stable result with less aggressive procedures. It is a new tool that is going to increase the autologous breast reconstruction in France.

Lipofilling, an efficient solution for breast sequelae after cardiothoracic surgery.

Evolutions in pediatric cardiovascular surgery have allowed the treatment of a various range of cardiovascular malformations in infants. It is a difficult branch of surgery, with vital impact, which can also leave residual thoracic scars, possible sources for thoracomammary deformities in adults. Most thoracomammary deformities after thoracotomy are observed at puberty, when they appear as breast asymmetries. The main cause is the breast bud injured during thoracotomy. Several techniques have been suggested for breast reconstruction, but none give satisfying results. We have been practicing lipofilling since 1998 for breast reconstruction. Since 2001, we have started applying it to breast deformities. The final result is constant in time, natural, and has a good volume filler effect. We describe the fat grafting technique, an original technique, as a solution for this kind of deformities. The technique is illustrated by two clinical cases. In conclusion, fat grafting has really improved breast asymmetry due to iatrogenic deformation. Even if those cases are rare, surgeons have to know this kind of procedure. It is indeed a simple and efficient solution for those patients after childhood, with natural and long standing results.

[Lipofilling and breast cancer: Literature review in 2015?]. / Lipofilling et cancer du sein : où en sommes-nous en 2015 ?

INTRODUCTION: The clinical surveillance of a patient treated for breast cancer involves many specialists: a surgeon, an oncologist, a radiotherapist, a gynecologist, and a general practitioner. The patients diagnosed with breast cancer will require regular clinical examination in order to identify possible recurrences. In our team, fat grafting has been used since 1998 for breast reconstruction because its results are natural breasts. Usually used as an adjuvant for flap or implant breast reconstruction, the lipofilling increases the aesthetic result and has a high satisfaction rate among patients. Despite of this advantage, some teams do not use lipofilling in patients with breast cancer history, because of doubts about oncology safety and screening difficulty. We performed an extensive review of the literature available regarding this subject. The purpose of this article is to evaluate the oncology safety of lipofilling in breast reconstruction after breast cancer. MATERIAL AND METHOD: A literature review was undertaken using PubMed. The key words searched were: breast lipofilling, breast reconstruction, breast cancer, and recurrence. RESULTS: The results of the literature review showed a reduced number of articles reporting recurrence after lipofilling. The retrospective studies included few patients and searched for multiple variables: histological type, stage, surgery, marginal invasion, distance between cancer surgery and lipofilling. In our research, we found no correct control group, except the series of Petit. The follow-up is relatively short (between 1 and 3years), except for the series of Rigotti. The recurrence cases after lipofilling in patients with extensive in situ carcinoma, in the series of Petit, raised the problem to be cautious with lipofilling after extensive in situ carcinoma. Other factors involved are the age of the patient and the distance between the cancer surgery and the lipofilling. CONCLUSION: Breast cancer is a disease that is well managed regarding treatment and follow-up. After reviewing the available literature, we consider that the lipofilling does not have a negative impact on the recurrence of breast cancer. There are however several precautions that must be taken into account in the sequelae of the conservative treatment (image exam before and after surgery, 3years delay of the procedure after the oncology treatment) and in the extensive in situ carcinoma. For this particular case of breast reconstruction using lipofilling, a multidisciplinary discussion of the reconstruction options might be a reasonable approach. It is important that the patients treated for breast cancer continue a clinical and imaging exam regardless of the breast reconstruction method, in order to identify a possible relapse as early as possible.

Breast lipofilling: A new treatment of Becker nevus syndrome.

INTRODUCTION: The association of Becker's nevus with other cutaneous, musculoskeletal or maxillofacial anomalies is called Becker nevus syndrome. Ipsilateral breast hypoplasia is the main reason for female patients to seek medical advice. We present two clinical cases of Becker nevus syndrome with thoracic nevus and ipsilateral breast hypoplasia treated with lipofilling alone (fat grafting). MATERIAL AND METHODS: For the two consecutive cases of Becker nevus syndrome treated by fat grafts, we present the surgical technique and the outcome at one year follow-up. Fat was harvested with cannula after infiltration. The adipose tissue was prepared with a short centrifugation. Fat grafting was realized as backward injections. RESULTS: We have noticed a concomitant improvement of the thoracic nevus color with a stable result after one-year follow-up. The aesthetic result after lipofilling was evaluated as very satisfying by the patient. The breast symmetry was improved. CONCLUSIONS: We believe that the lipofilling technique is a natural and valuable treatment option for thoracic anomalies in Becker nevus syndrome with a major impact on patient's quality of life.

[Percutaneous fasciotomies to improve fat grafting into the breast]. / Fasciotomies percutanées en complément des transferts graisseux: indications en chirurgie du sein.

INTRODUCTION: Breast reconstruction or for breast deformities is a difficult challenge to get excellent results. Lipomodeling technique can improve thoracic malformations and breast deformities. Percutaneous fasciotomies can be an excellent tool for recipient site improvement. The aim of this study is to discuss interest of percutaneous needle fasciotomies with fat grafting into breast surgery. MATERIAL AND METHODS: We have realized a retrospective study with fat transfer into the breast surgery. Recipient site prepared fasciotomies during fat grafting surgical procedure. Fat was harvested and centrifugated. Fat was injected into breast reconstructions or thoracic malformations. We did notice: population (age, BMI, uni/bilateral breasts), surgical procedure (mean sessions number, mean fat transfer). Aesthetic aspects of breasts were rated by both surgeon and patient: skin improvement, volume and shape of breast. Each complication was noticed: tissue wounds, scar evolution, hematoma, infection. RESULTS: We started a retrospective study between 2006 and 2011. One thousand patients were treated with fasciotomies and fat grafting during the same procedure. Main indications were breast reconstruction with latissimus dorsi flap, breast implant reconstruction, breast cancer conservative surgeries, tuberous breast and Poland syndrom. Sessions number expected was between 1 and 3. No complication has been noticed, except 1 tissular wound that needed a medical treatment to solve the problem. CONCLUSION: Fasciotomie is an indispensable complement tool for fat grafting. It is a safe and reliable technique. It improves aesthetic outcomes of breast surgery. Main indications of fasciotomies with fat grafting are breast reconstruction with radiation, breast cancer conservative surgery, and tuberous breast. Percutaneous fasciotomies provide excellent aesthetic result with no scar. They improve the shape of the breast with long-standing result.