Page 21 - Delaware Medical Journal - January 2016
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CASE REVIEW
While implant-based and autologous tissue reconstructions have become more common for these delayed cases, delayed reconstruction of partial breast deformities (lumpectomy or subtotal mastectomy) remains problematic. Methods which serve to magnify the deformity. The following case report technique for partial breast reconstruction — autologous fat grafting — which replaces the lost soft-tissue without the need for an implant or more invasive autologous tissue transfer.
Partial breast reconstruction, particularly reconstruction of the lower pole, poses a challenge to the reconstructive surgeon. Commercially available breast implants tend to enlarge the entire microvascular free tissue transfer surgeries are more often used for reconstruction of the entire breast, they can be used to replace smaller portions of the breast. However these procedures are invasive and convey greater donor site morbidity and cutaneous scarring. In contrast, autologous fat grafting is a less-invasive technique which utilizes low-suction liposuction for removal
of adipose tissue. The lipoaspirate is then processed to remove nonviable aqueous and free lipid components, and then this fat
graft is injected into the contour defect. Once revascularized, this grafted fat is said to have “taken,” and is relatively long-lasting.7
CASE REPORT
A 50-year-old female presented with complaints of contour deformity and asymmetry of her left breast after partial mastectomy. The patient had been diagnosed with ductal carcinoma in-situ in the lower pole of her left breast, and
sought breast-conserving therapy for treatment of this malignancy. She underwent left lower pole lumpectomy/
partial mastectomy, followed by external beam, whole breast radiation. Her postoperative course was uneventful, but over
the subsequent several years, she had developed radiation-
of the lumpectomy scar. The patient reported that she was unhappy with frequently having to pull the lower border of her bra down on this side, due to the absence of an inframammary fold to help maintain the garment in place. She consulted with several plastic surgeons who had advised her that implant
FIGURE 1
Preoperative views of a 50-year-old female after lumpectomy/partial mastectomy in left breast’s lower pole. She had developed scarring, post-radiation fibrosis, and contour deformity. Absence of a defined inframammary fold made wearing a brassiere difficult.
FIGURE 2
Preoperative anteroposterior view (left) and postoperative view (right) of the patient following two fat grafting sessions from the medial thighs and hips, to the lower pole of the left breast. Photo shows one year postoperative result from first fat graft procedure and 8 months after the second procedure.
Del Med J
| January 2016
| Vol. 88
| No. 1
21
