Reverse Expansion for Breast Reconstruction after Skin-sparing and Nipple-sparing Mastectomy: Our First 100 Cases

Abstract

Background: Patients with breast cancer have experienced advancements both in oncological treatment and in aesthetics as a result of developments in reconstructive techniques. We aimed to present our experience with the reverse expansion technique, summarizing the results of our first 100 cases of reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy. Methods: From January 2010 to September 2018, 253 breast reconstruction procedures were performed on 100 patients. The reverse expansion technique consists of autologous fat tissue transplantation requiring the combined use of a skin expander and of multiple lipofilling sessions. At the beginning of every session the breast expander was deflated by removing a saline volume similar to that of the fat to be injected. Results: Overall, 56 breast reconstructions after skin-sparing mastectomy and 44 after nipple-sparing mastectomy were performed. An average of 661.5 cm 3 of fat per session was harvested and an average of 305.3 cm 3 per breast was injected. The average number of sessions to achieve breast reconstruction was 2.53. Only four complications after 253 procedures (1.5%) were reported: one donor site hemorrhage due to genetic lack of coagulation factors, and three surgical site infections. Conclusions: Considering the large number of positive factors such as a fast postoperative recovery, an easy learning curve, a lack of need of a specialized surgical team, a natural look of the breast shape, and the soft consistency of the grafted tissue, we believe this technique could be the first choice for autologous reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy.

MRI-Conditional Breast Tissue Expander: First In-Human Multi-Case Assessment of MRI-Related Complications and Image Quality

“…Accordingly, the use of breast tissue expanders is of paramount importance to bridge the time until definitive reconstruction [ 16 , 17 , 18 ], such as in the case of inadequate perfusion of the mastectomy flaps, in the indication for post-mastectomy radiotherapy, in some form of immediate–delayed autologous breast reconstruction due to fully-booked operating room capacities [ 35 ], and in undecided patients. Furthermore, breast tissue expanders are more and more often used in several hybrid approaches, i.e., the gradual deflation of the expander while injecting stepwise aspirated autologous fat into the mastectomy flaps, eventually resulting in fully autologous breast reconstruction [ 36 ] or in hybrid breast reconstruction, using if possible a down-sized definitive implant [ 25 ]. This recent trend might be influenced by the fact that autologous flap-based breast reconstruction is associated with better functional and aesthetic outcomes and improved durability compared to implant-based breast reconstruction, despite higher risks of both minor and major complications [ 37 , 38 ].…”