gms | German Medical Science

Introduction: Fat tissue transplant is been approved as a save and reliable method for breast reconstructive issues in oncologic patients. Various clinical applications for autologous fat grafting to the breast have been described in literature [1]. Correction of soft tissue defects and deformaties after breast cancer or insufficient reconstruction can be achieved [2]. However complete breast reconstruction after total mastectomy is mentioned in few cases [3], [4]. Our multicenter study investigates in larger series the aspect of lipotransfer for total breast reconstruction after primary ablative surgery.

Material/Methods: In a retrospective clinical trial we analysed the data of 3 centers in Europe including a total of 54 patients (62 breasts) after uni - or bilateral radical mastectomy. Over 300 procedures were performed between 2008 and 2012. Inclusion criteria were fulfilled by 21 patients. Autologous fat grafting was done according to standardised protocol of the BEAULITM Method [5]. Clinical outcomes, patient satisfaction and aesthetic results were evaluated after a 6 months follow-up period. If available, comparative MRI volumetry was done for quantification [6].

Results: All patients showed remarkable increase of subcutaneous fat. On average 3,8 procedures with a single median volume of 150 ml (±57,4 ml) were performed till the end of treatment. A lipotransfer of 600 ml (±177 ml) was required for complete breast reconstruction. The median operation time was 40 min, but ranged to 60 min (±29 min) when additional operative steps (NAC reconstruction, abdominal advancement, contralateral mammaplasty) were carried out. 44,7% of the patients underwent their intervention in analgesic sedation. As a postoperative complication small singular oilcysts were estimate in 4 (2,6%) cases. Once granuloma was detached, but no infections. The majority of patients was very satisfied with the final result (Figure 1 [Fig. 1], Figure 2 [Fig. 2]).

Discussion: Breast lipografting in oncological patients is still considered as a delicate and riskful surgical approach. However this study supports the use of standardized protocols for autologous lipoaspirate grafting with longterm experience in order to provide optimized cosmetic outcome. It emphazises, that a “de novo” breast reconstruction is possible within 3–5 procedures of BEAULI^TM Method. These are combinable simultaneously with other oncoplasty techniques. Our reconstructive treatment is gradually attained after 12–18 months at least. Patients, who declined immediate reconstructive, prothesis-based approaches or experienced numerous complications after breast surgery are very satisfied with BEAULI^TM Method. In 4 years of experience we notice an increasing demand. Although further studies are certainly required to determine definitive guidelines for lipotransfer in breast surgery, it might be regarded as an evolving and promising alternative to conservative methods.