Hybrid Prepectoral Direct-to-Implant and Autologous Fat Graft Simultaneously in Immediate Breast Reconstruction: A Single Surgeon's Experience with 25 Breasts in 15 Consecutive Cases.

BACKGROUND: The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction. METHODS: In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G). RESULTS: The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed. CONCLUSIONS: The authors' hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[BREAST RECONSTRUCTION WITH THE BRAVA DEVICE AND AUTOLOGOUS FAT].

AIMS: To report our experience and results in BRAVA breast pretreatment for full breast reconstruction by autologous fat grafting. BACKGROUND: BRAVA (bra like vacuum-based external tissue expander) is a method developed to expand the skin envelope, thus creating more space for the fat graft for breast reconstruction. METHODS: Since 2015 we began to perform a full breast reconstruction by BRAVA and autologous fat grafting. This is a multiprocedure breast reconstruction that includes pretreatment by using the BRAVA device for 180 hours before each surgery. We will focus on the number of procedures and time duration that was needed to complete the breast reconstruction the aesthetic results and the complication rates. RESULTS: Between the years 2015-2019 we preformed 13 late full breast reconstructions using the BRAVA. Six women were post-radiotherapy and they completed their breast reconstruction after 5.7±1.3 rounds during 20.3± 5.3 months. Non-irradiated patients completed their breast reconstruction after 2.7±0.5 rounds during 9.4±2.6 months. We grafted an average volume of 218±16.7 ml of fat per surgery. This was in comparison to an average of 100ml fat volume grafted in surgery without pre-expansion according to the literature. We had no complications and the aesthetic results were satisficing. CONCLUSIONS: The addition of BRAVA expansion procedure before autologous fat grafting leads to a larger volume of fat that can be injected in every operation and reduction of procedures. The procedure is safe and with good aesthetic results.