Large Volume Fat Grafting to the Breast with External Expansion
We report our technique for external expansion with large volume autologous fat transfer (AFT) and experience with forty-nine consecutive patients from a single surgeon’s practice from 2013 to 2021.
Methods/Technique:
Our technique entails 21 days of pre-expansion for six consecutive hours per day. Fat is harvested with standard liposuction technique from available donor sites and triple irrigated. Prepared fat is then injected into the subcutaneous plane, subglandular plane, and peripheral breast following needle band release as needed. Care is taken to avoid pooling of fat. No post-operative expansion is required. Final results are assessed at six months, when additional fat grafting can be planned if needed.
We performed a retrospective analysis of consecutive patients undergoing fat grafting to the breast with the use of pre-expansion. Indications for surgery included primary breast augmentation, breast asymmetry, congenital breast deformity or the management of secondary breast problems such as implant visibility, post-explantation deformity or tissue necrosis. Patients were treated with external expansion and large volume AFT and included for analysis if they had a clinical problem amenable to correction with large volume fat injection, adequate donor sites, and were willing to undergo pre-surgical preparation with external expansion. Data was collected through chart review performed by a single researcher and de-identified. Demographics, diagnosis, radiation status, volume grafted, complications, and adjunct/secondary procedures were recorded. Representative case photographs were included with patient permission.
Results/Complications:
A total of 49 patients underwent external expansion with AFT by a single surgeon. Twenty-three patients (47%) had aesthetic or hypoplastic indications. This group included patients with congenital pre-operative diagnoses of tuberous breast deformity (n=9) and Poland syndrome (n=1). Seventeen patients (35%) had indications for secondary breast revision of previously placed implants. Nine patients (18%) utilized the procedure for primary oncologic breast reconstruction.
The BRAVA (®) external expander was used in 40 patients and the Noogleberry (®) device in the remaining nine. A total of 71 procedures were performed. A majority of patients (n=33, 67%) had one procedure, with an average of 1.45 procedures per patient. The average volume of fat grafted per breast was 372 cc for hypoplasia, 240 cc for secondary breast revision, and 429 cc for oncologic reconstruction indications. Concurrent procedures included implant exchange, implant removal, mastopexy, and breast reduction. Follow-up ranged from 1 to 84 (average=20) months.
One major complication of recipient site hematoma requiring evacuation occurred. Three patients experienced mild donor site irregularity and two reported overcorrection. We did not identify any patients with post-operative fat necrosis, breast lumps, or cysts.
Conclusion:
Our experience shows promising results with external expansion and large volume fat grafting to the breast for a variety of indications. This technique can be considered as an alternative to alloplastic augmentation or reconstruction in appropriate patients with available donor sites and the motivation to tolerate pre-expansion.