Total Breast Reconstruction with Fat Grafting Combined with Internal Tissue Expansion

Kolasiński, Jerzy

doi:10.1097/gox.0000000000002009

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…[26][27][28] The first reports of cases of breast reconstruction with FG after total mastectomy are equally optimistic. 29 The effectiveness of the method is greater after the sparing operations. On the other hand, the use of breast reconstruction after total mastectomy is more spectacular and, at the same time, radiotherapy is used less frequently in these patients than after conserving procedures, which makes FG more effective after total mastectomy.…”

Section: Discussionmentioning

confidence: 98%

Fat Grafting following Internal Tissue Expansion: An Option for Breast Reconstruction after Total Mastectomy

Kolasiński¹,

Pyka²

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction is currently performed as standard practice. Methods: A prospective study was performed of patients after total mastectomy who underwent autologous breast reconstruction with fat grafting (FG) combined with internal tissue expansion between September 2015 and December 2020. The patients were classified into groups A to F depending on the steps of breast reconstruction. Groups A and B described patients with completed breast reconstruction with FG and expander removal, with or without nipple/areola complex reconstruction. C described patients during deflation of the expander combined with simultaneous FG. D described patients after expander implantation and refilling. E described patients after first FG, and F included patients who discontinued reconstruction with the described method and converted to reconstruction with a breast implant. Results: Among 22 treated patients‚ two were after first FG (9.09%‚ group E), two were after expander implantation and refilling (9.09%‚ group D), three were during deflation of the expander combined with simultaneous FG (13.63%‚ group C), and four (18.18%) had completed breast reconstruction-two (9.09%) without NAC reconstruction and symmetrization (group B) and two (9.09%) with completed breast reconstruction (group A). In 11 patients (50%), breast reconstruction was abandoned after expander implantation and one to three FG procedures (group F), converting to breast reconstruction with a breast implant. Conclusions: This study demonstrated successful breast reconstruction using FG and expander implantation. Breast reconstruction using this method is safe and enables possible abandonment at any treatment stage, as well as conversion to breast reconstruction with implants.

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Section: Discussionmentioning

confidence: 98%

Fat Grafting following Internal Tissue Expansion: An Option for Breast Reconstruction after Total Mastectomy

Kolasiński¹,

Pyka²

2022

Plastic and Reconstructive Surgery - Global Open

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“…Other rarely used free flaps are lumbar artery perforator (LAP) flap, Gluteal artery perforator (GAP) free flap, Upper gracilis flap (either transverse TUG, vertical VUP, or diagonal DUG), profunda artery perforator (PAP) flap, and lateral thigh perforator (LTP) flap [34] . While implant-based reconstruction requires a shorter operative time, autologous flap-based reconstruction such as latissimus dorsi (LD), transverse rectus abdominis (TRAM), and deep inferior epigastric perforator (DIEP) flaps often yield more satisfactory results for patients [35][36][37][38][39] . Sinna et al and Bennet et al reported flap-based reconstruction to provide higher satisfaction and psychological and sexual well-being than implant-based reconstruction [40,41] .…”

Section: Reconstruction With Autologous Flapsmentioning

confidence: 99%

Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

Shaaban¹,

Gourichon²,

Cruz³

et al. 2023

Plast Aesthet Res

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Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures. Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability; it can be used independently to replace more invasive flap procedures or implants, or as an adjunct for smaller volume supplementation. The breadth of applications in the breast necessitates diversity in technique and approach, and while there is no universally agreed-upon protocol, basic principles have guided the evolution of some commonly adopted tenets. Broadly, fat grafting outcomes are highly favorable but dependent on patient and procedure factors, requiring learned patient selection and expertise in recipient site assessment. Common complications from fat grafting, such as fat necrosis and the development of nodules, are particularly troublesome for post-oncologic patients, requiring considerable pre-surgical consultation for patient education and managing expectations. In addition to volume and contour augmentation, fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or post-mastectomy pain syndrome, improved skin quality and reduced fibrosis following radiation, and possible anti-tumorigenic effects. New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma. Preclinically, research towards safe and effective regenerative medicine approaches is actively underway, with the ultimate goal of achieving predictable and increased graft retention, reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.

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“…24 In this methodology, an expander was inserted in a prepectoral position to generate a capsule, followed by serial sessions of deflation and AFG, with the expander removed at the completion of treatment. [24][25][26] Although this protocol may be an interesting alternative for many patients, additional studies are required to verify all potential benefits and complications. A detailed analysis of all studies is reported in Table 1.…”

Section: Eve In Combination With Afg For Breast Reconstructionmentioning

confidence: 99%

The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration

Chen

Yuan

2021

Tissue Engineering Part B: Reviews

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The reconstruction of large-volume soft tissue defects is a major problem in plastic surgery. Many plastic surgeons have focused on external volume expansion (EVE) because of its capacity to promote regeneration of soft tissues, including breast, subcutaneous fat, and skin. EVE is a minimally invasive and less costly tissue engineering approach that has shown great clinical potential. However, many challenges still need to be addressed before such technology can become a common clinical practice. Basic in vivo and in vitro studies have been performed to determine the possible mechanisms by which EVE promotes tissue regeneration and to design optimized animal models. EVE application was found to facilitate cell proliferation and migration, enhance adipogenesis, improve angiogenesis, and provide available space for soft tissue growth. Understanding the mechanical and chemical signals associated with EVE during tissue regeneration may enable the clinical adaptation of this technology. This article reviews the clinical application of EVE techniques, describes preclinical animal models, and evaluates the possible mechanisms by which EVE induces tissue regeneration.

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Total Breast Reconstruction with Fat Grafting Combined with Internal Tissue Expansion

Abstract: Supplemental Digital Content is available in the text.

Cited by 14 publications

References 21 publications

Fat Grafting following Internal Tissue Expansion: An Option for Breast Reconstruction after Total Mastectomy

Fat Grafting following Internal Tissue Expansion: An Option for Breast Reconstruction after Total Mastectomy

Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration

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