The Breast-Pectoralis Flap: A New Advance in Autologous Breast Reconstruction-A Preliminary Report on 20 Cases.

BACKGROUND: In the past, several publications have described breast reconstruction techniques that utilize the contralateral breast; however, interest diminished because of technical difficulty, scarring, and poor aesthetic results. OBJECTIVES: This study aimed to present a new breast reconstruction technique that uses a combination of the breast-pectoralis flap and the abdominal advancement flap. METHODS: This retrospective study analyzed the results and complications of 20 consecutive breast reconstructions with the breast-pectoralis flap technique. RESULTS: The authors present a series of 20 breast reconstructions that utilized the breast-pectoralis flap. Delayed breast reconstruction was performed in 13 cases (65%), breast reconstruction in 5 patients (25%) with Poland syndrome, sequela correction after a chest wall sarcoma in 1 patient (5%), and sequela correction after breast cystic lymphangioma resection in 1 patient (5%). One complication required surgical reintervention without long-term consequences. The outcomes were considered very good in 50% of the cases, good in 45%, and fair in 5%. CONCLUSIONS: The combination of the breast-pectoralis flap and the abdominal advancement flap is an interesting advance in breast reconstruction. Evaluation of the presented cases suggests wider indications for this technique.

Dorsal Lipomodeling to Treat Donor Site After Latissimus Dorsi Flap: Safety and Effectiveness.

BACKGROUND: The latissimus dorsi flap (LDF) is a classic and efficient technique for breast reconstruction. However, its use has recently diminished in surgical practice due to dorsal disadvantages and to the increased use of microsurgical techniques for breast reconstruction, such as the deep inferior epigastric artery perforator flap. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of managing dorsal problems such as asymmetry, irregularities, and dysesthesia by lipomodeling the back region during the associated surgery for breast reconstruction. METHODS: A series of 300 patients operated by the last author for dorsal lipomodeling to correct sequelae after harvesting the total LDF, between November 2012 and March 2019, was analyzed. RESULTS: The results show a very good improvement in the dorsal region in 6.7% of cases, good improvement in 86.7% cases, and fair improvement in 6.7% of cases. There was a good improvement in dorsal comfort in 90% of cases, a very good improvement in 6.66% of cases, and a fair improvement in 6.66% of cases. In 5% of cases 2 sessions were required to obtain a satisfactory result. No major complications were registered, and the only complication encountered were oil cysts in 2.6% of cases that were treated during consultation with percutaneous puncture. CONCLUSIONS: This study showed that lipomodeling in the back area after LDF harvesting is an efficient and safe technique that corrects secondary dorsal sequelae such as irregularities, asymmetry, sensitivity, and dysesthesia. This technique should increase the indications for LDF because it decreases donor site sequelae, which are some of the main drawbacks of the LDF approach.

Breast asymmetry and pectus excavatum improvement with fat grafting.

BACKGROUND: In women, pectus excavatum malformation can cause modified breast morphology, resulting in mammary asymmetry, which can be increased by placing mammary implants alone. Fat transfer can be an elegant solution to increase the volume and projection of the breast. OBJECTIVES: The authors discuss their experience treating pectus excavatum with fat transfer (lipomodeling) since 2000. METHODS: The charts of 19 consecutive patients with a pectus excavatum breast asymmetry who underwent lipomodeling treatment at the authors' facility between January 2000 and November 2011 were retrospectively reviewed. Patients were separated using the Chin classification (type 1, 2, and 3). Data points for each patient included age and body mass index, number of interventions and volume of fat injected during each session, total volume transferred, and postoperative complications. The clinical result was evaluated by the patient and the surgical team on a 4-point scale: very good, good, fair, or poor. RESULTS: Most (74%) patients in this series had type 3 Chin pectus excavatum. The average age was 28 years, and the average body mass index was 20.3. The average number of lipomodeling sessions was 1.63, and the average volume of fat transferred was 230 mL per session and 375 mL total. The patients and the surgical team were very satisfied or satisfied in 95% of cases and considered the result fair in 5% of cases. There were no complications. CONCLUSIONS: Fat transfer for treatment of pectus excavatum yields very good (natural and stable) results and high patient satisfaction rates, which makes this technique our preferred method for treating thoracomammary malformations in pectus excavatum.

Breast amputation correction of a horse bite using the lipomodeling technique.

UNLABELLED: Mammary gland development is an important phase of puberty, and it marks the passage into adulthood for women, so any trauma leading to mammary deformities has an important physical and psychological impact. Often, classic techniques are difficult to use in the treatment of traumatic breast lesions. In this article, the authors present an exceptional case of breast reshaping by lipomodeling in a teenage patient who had experienced a horse bite. Treatment included 2 fat grafting sessions with fasciotomies, nipple reconstruction using a bifoliated flap, and areolar tattooing, all without any complications. We achieved a satisfactory result with a symmetric volume, a natural tissue consistency, and sensation improvement, all of which were maintained as the patient grew. In our experience, fat transfer was a safe and reliable technique that provided a good and stable aesthetic result, improving the volume and shape without additional scarring or implant devices. LEVEL OF EVIDENCE: 5.

Indications and Controversies in Lipofilling for Partial Breast Reconstruction.

The treatment of sequelae after conservative breast cancer treatment can be a challenge. Lipomodeling, although controversial in the beginning, is a safe technique that can help in the treatment of these deformities, without an important impact on the imaging surveillance. Depending on the severity of the deformity, one or several sessions of fat transfer can be required. The technique is easy and reproducible, but before obtaining satisfying results with a low complication rate, a learning curve should be completed. The final result is natural, with normal breast consistency, with no additional scars.

Indications and Controversies in Total Breast Reconstruction with Lipomodeling.

Complete breast reconstruction with fat grafting is an appealing technique because it does not add scars or use flaps, is autologous, and has the secondary benefit of liposuction. It is a multiple stage surgery and usually requires balancing of the contralateral breast. After using this technique since 2001, the authors narrowed the indications, the ideal candidate being a patient with small breasts and enough donor sites for up to 4 or 5 lipomodeling sessions. Breast reconstruction with fat grafting alone in total breast reconstruction has very limited indications, because lipomodeling in combination with other autologous reconstruction gives very nice results.