Breast Reconstruction For Congenital Breast Asymmetry Using Fat Grafting and External Pre-Expansion - A Case Report
Daniel A. Del Vecchio.
Mass General Hospital, Boston, MA, USA.
Young patients presenting with significant breast asymmetry are often treated with unilateral or bilateral breast augmentation using different-sized implants. Often, the aesthetic results in this group of patients are less than ideal. These individuals may end up having multiple procedures over the course of their lifetimes.
The recent evidence that transplanted fat volumes can be retained using external pre-expansion at the recipient site may be due to expanding the interstitial volume of the breast parenchyma and by increasing the recipient site microcirculation. Both of these effects would in theory increase the likelihood that transplanted adipocytes would survive in the recipient site by oxygen diffusion in the early days following fat grafting.
Under IRB approval, the above considerations were deliberated in the case of a 20 year-old college student with severe breast asymmetry following the central excision of a breast lesion as a child. She demonstrated volume deficiency as well as vertical skin deficiency, similar to that of a subcutaneous mastectomy patient. Pre-operative breast MRI was obtained to document quantitative breast volume. The patient underwent 4 weeks of nightly external pre-expansion using a negative pressure bra dome and a vacuum pump. In the preoperative holding area at the time of her procedure, the expanded breast had doubled in size and she underwent a 320 cc fat grafting to the breast. The author’s preoperative evaluation, surgical technique and postoperative results are submitted in a short video format.
Serial examinations at 3 and 6 months demonstrated a very satisfactory aesthetic result, with acceptable symmetry, natural contour and volume retention on the reconstructed breast. Post-operative breast MRI revealed volume retention and significant increase in volume over the pre-operative MRI, with no evidence of oil cysts or other pathology in the reconstructed breast.
Unilateral fat grafting to the breast in the young patient with breast asymmetry may become a viable alternative to implant reconstruction. IRB approved safety and outcome studies are needed and are being conducted to help define the long term safety and efficacy of breast fat transplantation.