Regardless of the reconstruction technique, autologous tissue (fig. 1) or implants (fig. 2), the general shape and contour of the breast can be improved by adding small quantities of fat.
|Fig. 1a||Fig. 1b||Fig. 1c|
|Fig. 2a||Fig. 2b||Fig. 2c|
Fig. 1: (a) DIEAP flap breast reconstruction with hollowing in the décolleté area. (b,c) Result after lipofilling.
Fig. 2: (a) Bilateral implant based breast reconstruction. (b) Improvement of both breasts using lipofilling.
Contour improvement and contralateral breast augmentation
Instead of detaching and remodeling the entire flap in a secondary operation (through the same scars), flap remodeling is now performed by local liposuction to remove excess of volume and lipofilling in order to locally add some volume. In addition, a simultaneous augmentation of the other breast can be performed.(fig. 3)
|Fig. 3a||Fig. 3b|
Fig. 3: (a) Left DIEAP flap reconstruction. Remodeling by liposuction and lipofilling. (b) Post-operative appearance after remodeling of the left breast and lipofilling-augmentation of the right breast.
Lipofilling after breast conserving surgery
If only small amounts of breast volume are missing, the depression can easily be filled up by one or more short sessions of lipofilling (fig. 4, 5). If the overlying skin is too tight as a result of radiotherapy, an initial low volume lipofilling is performed just below the skin in order to regenerate elasticity of the irradiated skin. In later procedures, volume is restored once expansion of tissues is possible.
|Fig. 4a||Fig. 4b|
|Fig. 4c||Fig. 4d|
Fig. 4: (a, b) Satus after tumorectomy and adjuvant radiotherapy of the left breast (arrow). (c, d) Status 1 year after simple lipofilling of the defect. The skin color and elasticity have improved.
Fig. 6: (a) Pre-operative view of a woman diagnosed with a BRCA-2 gene mutation after tumorectomy of the left breast. (b) Status after bilateral areola-sparing mastectomy, bilateral immediate breast reconstruction by DIEAP flaps, nipple reconstruction and tattoo. (c) an augmentation of the volume of the flap/breast can easily be obtained by simple lipofilling (280cc of fat was injected on each side)
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