Breast Reconstruction After Mastectomy with Lipofilling

Fig. 51.1

(a, b) Preoperative view. A 48-year-old patient had cancer recurrence in the right breast 8 years after quadrantectomy, radiation and chemotherapy. A (skin-sparing) mastectomy and reconstruction with lipofilling were planned. The drawing shows the incisions for mastectomy

51.2 Surgery

A skin-sparing mastectomy was performed. Reoperation sentinel node biopsy found two negative nodes. In order to obtain an adequate skin envelope for fat grafting, expansion of the skin was done with a 250 cc anatomical expander, which was implanted totally submuscularly. The expander was filled intraoperatively with 50 cc of NaCl solution; a drainage in the submuscular pocket was used for 4 days.

After 2 weeks the expander was repeatedly filled with 50–100 cc NaCl solution every 2 weeks in the outpatient clinic. The expansion volume of 270 cc was reached after 2 months. After another 2 months of expansion, 200 cc of fat was harvested from the abdomen using the Body Jet Lipoaspiration system. The expander was deflated off 100 cc fluid and 200 cc of fat were injected in the subcutaneous tissue. Following another 2 months the expander was completely deflated and removed and liposuction/lipofilling was repeated with 250 cc of fat from the buttocks injected into the breast (Fig. 51.2).

Fig. 51.2

Intraoperative view. The expander was removed and the expander volume was substituted equally with fat injected subcutaneously and into the major pectoralis muscle

51.3 Clinical and Cosmetic Outcome

Postoperative course was uneventful. Following 2 years after reconstruction with autologous fat, the patient showed a smooth breast of good volume and with symmetry to the left breast (Fig. 51.3a, b

Only gold members can continue reading. Log In or Register to continue