Breast reconstruction de novo by water-jet assisted autologous fat grafting--a retrospective study

Abstract

Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone.

Methods: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.4 years). All women were treated with the water-jet assisted fat grafting method (BEAULI™) combined with additional procedures (NAC reconstruction, contralateral mastoplasty) and evaluated with at least 6 months follow-up (mean 2.6 years). Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale) and digital photographs were carried out.

Results: On average the patients received 4 to 6 procedures each with a single volume of 159 ml (±61 ml) over 21 months (range 9 months to 2.5 years). In total 1,020 ml (±515 ml) fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041). Main treatment complications were liponecrosis (2.59%), infection (0.74%) and granuloma (0.74%). Patient satisfaction was overall high to very high (96%) and confirmed the good aesthetic results (68%) and the natural softness, contour and shape of the reconstructed breast.

Conclusions: A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.

Keywords: autologous fat grafting; breast reconstruction; lipotransfer; mastectomy.

Table 1. Demographics, comorbidities, treatment and impact (BMI, Body Mass Index; SD, standard deviation)

Figure 1. Figure 1: Numbers of procedures with median volumes (ml) grafted

Figure 2. Figure 2: Median operation time (min) per procedure (P1–P10)

Figure 3. Figure 3: Recorded complications in all procedures

Figure 4. Figure 4: Evaluation of patient questionnaire (10-point Likert scale)

Figure 5. Figure 5: Results of the aesthetic outcome (5-point ranking scale)

Figure 6. Figure 6: 56-year-old patient after total mastectomy left side in 2006. Outcome after 3 months (a) 300 ml grafted in P1, (b) 250 ml in P2. Below result (c) after P3 with 230ml transfered and (d) P4 with 210 ml combined with NAC reconstruction. Follow-up results after 12 months (e) and 18 months (f).

Figure 7. Figure 7: 66-year-old patient after total mastectomy left side in 2002 with PMRT. Outcome in March 2009 after P1 (250 ml) and P2 (250 ml). Below results after three more sessions (P3 with 200 ml, P4 with 150 ml, P5 with 300 ml plus NAC reconstruction) and 3 months follow-up in June 2010. Final outcome after P6 with 100 ml, P7 with 250 ml and 6 months follow-up in December 2011.