Intratissular expansion–mediated, serial fat grafting: A step-by-step working algorithm to achieve 3D biological harmony in autologous breast reconstruction

Background Breast reconstruction involves the use of autologous tissues or implants. Occasionally, microsurgical reconstruction is not an option because of insufficient donor tissues. Fat grafting has become increasingly popular in breast surgery. The challenge with this technique is how to reconstruct a stable and living “scaffold” that resembles a breast. Methods Breast reconstruction (n = 7) was performed using intratissular expansion with serial deflation–lipofilling sessions. Mean age of the patients was 41 years (22–53). The expander generated a vascularized capsule at 8 weeks, which demarcated a recipient site between the skin and the capsule itself, and functioned as a vascular source for angiogenesis. Serial sessions of deflation and lipofilling were initiated at 8 weeks with removal of the expander at the completion of the treatment. An average of 644 ml (range, 415 ml–950 ml) of lipoaspirate material was injected to reconstruct the breast mound. An average of 4 (range, 3 to 5) fat-grafting sessions with a 3-month interval was needed to achieve symmetry with the contralateral breast. The average follow-up was 14 months (range, 9–29 months). MRI examination was performed at 8 months to analyze tissue survival and the residual volume. Results MRI examination retained tissue survival and the mean reconstructed breast volume was 386 ml (range, 231 ml–557 ml). An aesthetically pleasant breast mound was created, with a high satisfaction rate. Conclusion We could reconstruct an aesthetically pleasant and stable breast mound in a selected group of patients by using intratissular expansion and fat grafting.