Abstract P4-13-10: Autologous immediate and delayed breast reconstruction utilizing micro fat grafts with and without dermatocutaneous flaps: A novel minimally invasive approach for reconstruction of small and medium size breasts
Authors: Goldman BE , Cheng ZHM , Capasse JS , Staradub VL 
Published: February 2018

Background:Immediate breast reconstruction following mastectomy is a key quality metric of a comprehensive breast cancer program. Reconstructive options include autologous (DIEP, TRAM, Latissimus) and implant/ADM reconstruction. DIEP, TRAM, and Latissimus flaps are invasive procedures that require prolonged operative times, extended recoveries, and have donor site morbidity (scars, weakness, hernia, etc). Implant/ADM reconstruction historically has not provided the same aesthetic satisfaction as autologous reconstruction, and also requires monitoring and ultimate replacement of the prosthetic device. Fat grafting has been found to be a safe and effective adjunct to standard breast reconstructive techniques. Fat graft only breast reconstruction has been reported, but in conjunction with external suction based tissue expansion. Dermatocutaneous flaps have been described for immediate breast reconstruction, but only in large breasted women (Goldilocks technique). We used micro fat grafts alone (no pre expansion) and in combination with dermatocutaneous flaps at mastectomy, to reconstruct small to medium sized breasts. We have applied the fat graft only technique to both immediate and delayed reconstructions.

Purpose: To present a novel, minimally invasive approach to reconstruction of small and medium sized breasts utilizing immediate or delayed micro fat grafts with and without immediate dermatocutaneous flaps. We also present immediate single stage bilateral breast reconstruction utilizing fat grafts, dermatocutaneous flaps, and nipple reconstruction. The authors will review patient selection criteria, surgical technique and present before and after photos.

Results: 12 non radiated breast cancer patients underwent immediate reconstruction of 21 breasts, utilizing fat grafting (1 breast) or dermatocutaneous flaps and fat grafting (20 breasts). An additional 5 patients underwent a total of 8 delayed fat graft only breast reconstructions. A total of 17 patients underwent reconstruction of 29 breasts. One patient underwent immediate reconstruction of one breast and delayed reconstruction of the other. Average age=54 years. Average BMI=27.4. All immediate breast reconstruction patients were discharged home next day. Patients underwent a mean=2 (range 1-5) fat graft sessions. Average fat injected per session was 153 ml (range 50-325). For immediate fat graft reconstructions, volume of fat grafted at the time of the mastectomy averaged 76 ml (range 55-100 ml). Total mean follow up from first procedure was 9 months, range 3-24 months.

Conclusion: The authors present a simple, minimally invasive approach to immediate and delayed breast reconstruction of small to medium sized breasts. Our approach is novel in that it combines fat grafts with dermatocutaneous flaps for immediate reconstruction and utilizes serial fat grafts without pre expansion for complete delayed breast reconstruction. The technique has been successfully utilized to complete both immediate unilateral and bilateral breast reconstruction in a single stage in select patients and with serial fat grafts in others. This is the largest series to date using this approach.

Citation Format: Goldman BE, Cheng ZHM, Capasse JS, Staradub VL. Autologous immediate and delayed breast reconstruction utilizing micro fat grafts with and without dermatocutaneous flaps: A novel minimally invasive approach for reconstruction of small and medium size breasts [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-10.