Refined Method of Lipofilling following DIEP Breast Reconstruction

Abstract

Background:The deep inferior epigastric perforator (DIEP) flap technique gives good clinical results, but aesthetic surgical adjustments are often necessary. Lipofilling represents a good complementary method, but fat resorption within the few months after surgery limits its use. Recently, a new protocol was introduced and successfully evaluated on murine models. This study aims to evaluate this protocol following a DIEP procedure by three-dimensional analysis.Methods:Within a period of 4 months, every patient having undergone breast reconstruction with DIEP and who required a lipofilling adjustment was invited to take part in this study. All surgeries were performed using the Adip’sculpt disposable medical device MACROFILL (Laboratoires SEBBIN, Boissy-l’Aillerie, France). Fat resorption was analyzed using a three-dimensional photography system.Results:Twenty-three patients were included, with a total of 25 breasts operated on. Injections were carried out on irradiated breasts in 73% of cases, and average injection volume was 124 mL (SD = 39 mL), whereas average operating time was 68 minutes (44–96 minutes). At an average follow-up of 5 months (4–8 months), 70.9% of projection gain afforded by the lipofilling was still present.Conclusions:It is now clear that particular rules should be respected for an efficient lipofilling, particularly regarding aspiration cannula characteristics, vacuum used, and the necessity of washes and soft centrifugations. We demonstrate here that by following a specific protocol that addresses these precautions, while using material that is specifically adapted, a 70.9% fat survival rate can be achieved, even in the very unfavorable case of postirradiation DIEP breast reconstruction.

Comparative Analysis of a New Automatic System and Four Existing Techniques for Autologous Fat Grafting

“…5B). Results of Macrofill in mice (75% graft efficiency) are close to those obtained clinically for breast reconstructions in a study dedicated to this device 36 where authors obtained a graft survival rate of 70%. Surprisingly, in vitro, results seem to favor the Coleman method over the Macrofill device, whereas the Macrofill purification conditions are rather in favor of adipose tissue preservation (lower speed + washes).…”

Conversion to Autologous Breast Reconstruction with Latissimus Dorsi and Immediate Fat Grafting in Patients with Previous Implant Failure: An Efficient, Reproducible, and Safe Technique

“…These data support FALD as a safe technique, even in patients with obesity, in which microsurgical ABR may present slightly increased rates of flap loss. 7 33 …”

The 10-Year Experience with Volume Distribution Mastopexy: A Novel, Safe, and Efficient Method for Breast Rejuvenation

“…22 Eventually, fat grafting for further volume enhancement and projection can be considered as an adjunct tool in some patients, mainly to achieve upper pole fullness. 23,24 Its effect on the perceived success of the result is not significant nonetheless, most likely because patients who did not undergo adjunct fat grafting did not require the extra "effect" that lipofilling would offer, which emphasizes the importance of proper patient selection when performing fat grafting.…”