Paralumbar compartment syndrome, a rare sequela of deadlifting: a case report and review of current literature.

BACKGROUND: Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting. CASE PRESENTATION: 53-year-old male who presented with progressively worsening low back pain and paresthesias one day after high-intensity deadlifting. Laboratory testing found the patient to be in rhabdomyolysis; he was admitted for intravenous fluid resuscitation and pain control. Orthopedics was consulted, and Magnetic Resonance Imaging revealed significant paravertebral edema and loss of muscle striation. Given the patient's lack of improvement with intravenous and oral pain control, clinical and radiographic findings, there was significant concern for acute paralumbar compartment syndrome. The patient subsequently underwent urgent fasciotomy of bilateral paralumbar musculature with delayed closure. CONCLUSION: Given the paucity of literature on paralumbar compartment syndrome, the authors' goal is to promote awareness of the diagnosis, as it should be included in the differential diagnosis of intractable back pain after high exertional exercise. The current literature suggests that operative cases of paralumbar compartment syndromes have a higher rate of return to pre-operative function compared to those treated non-operatively. This case report further supports this notion. The authors recommend further study into this phenomenon, given its potential to result in persistent chronic exertional pain and irreversible tissue damage.

Delayed Presentation of Acute Compartment Syndrome After Isolated Closed Fibular Shaft Fracture: A Case Report.

Post-traumatic compartment syndrome in the lower extremity has been commonly associated with fractures of the tibia. Only in rare cases, this critical condition might be related to isolated fibular fractures. We present a rare case of delayed onset of acute compartment syndrome after a solitary fracture of the fibula. A 40-year-old man with a history of coagulation disorders due to hepatic cirrhosis was admitted to a neighboring hospital after a car accident with left-sided fractures to ribs 9 and 10 and a transverse fracture in the mid-shaft of the left fibula. He was discharged from the hospital five days later with a posterior long leg splint and anticoagulant therapy. However, three days after discharge, he was seen in the emergency department of our hospital with severe pain and extensive swelling in the left leg. Weak posterior tibial and dorsalis pedis pulse in the right foot were detected. Moreover, sensory disturbances were found in the tibia and foot. Passive hallux dorsiflexion and plantar flexion were causing acute intense pain. A triplex ultrasound was negative for deep vein thrombosis. Apart from the clinical findings, the diagnosis of compartment syndrome was confirmed after evaluating intracompartment pressure measurements. The patient was taken emergently to the operating room for four-compartment fasciotomies. A large intramuscular hematoma was evacuated. Skin closure was accomplished in two stages within two weeks. Six weeks postoperatively, there was no sign of compartment syndrome sequelae and the patient was free of symptoms without any neurovascular deficiency in the operated limb and walked without crutches. Ten weeks later, he returned to his pre-injury daily activities. Although the majority of compartment syndrome cases are reported after high-energy trauma, patients with both coagulation disturbances and anticoagulation treatment are at higher risk of developing compartment syndrome secondary to simple fracture patterns.

Cost-effectiveness of adalimumab for early-stage Dupuytren's disease : an economic evaluation based on a randomized controlled trial and individual-patient simulation model.

AIMS: To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren's disease (DD) and the value of further research from an NHS perspective. METHODS: We used data from the Repurposing anti-TNF for Dupuytren's disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded. RESULTS: The within-trial economic evaluation found that adalimumab plus standard care cost £503,410 per quality-adjusted life year (QALY) gained versus standard care alone over a 12-month time horizon. The model-based extrapolation suggested that, over a lifetime, repeated courses of adalimumab could cost £14,593 (95% confidence interval £7,534 to £42,698) per QALY gained versus standard care alone. If the NHS was willing to pay £20,000/QALY gained, there is a 77% probability that adalimumab with retreatment is the best value for money. CONCLUSION: Repeated courses of adalimumab are likely to be a cost-effective treatment for progressive early-stage DD. The value of perfect parameter information that would eliminate all uncertainty around the parameters estimated in RIDD and the duration of quiescence was estimated to be £105 per patient or £272 million for all 2,584,411 prevalent cases in the UK. Cite this article: Bone Jt Open 2022;3(11):898-906.

Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment.

The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS.

How Do Positions of Nipple and Inframammary Fold Change After Autologous Breast Augmentation with Fat Grafting?

BACKGROUND: Breast augmentation with autologous fat grafting was widely used. However, it is unclear how does this kind of surgery affect the morphologic change of breast. This study aimed to explore the change of nipple and inframammary fold (IMF) levels, which are important aesthetic landmarks of breast that further explore whether this kind of surgery could correct the asymmetry of nipple and IMF. METHODS: Preoperative and postoperative measurements were performed in the patients who received fat grafting with or without fasciotomy. The position levels of nipple and IMF were measured. The preoperative and postoperative discrepancies and the difference of these levels after surgery were also calculated. RESULTS: As for the IMF asymmetry, in the fasciotomy plus fat grafting group, the asymmetry was significantly reduced after surgery, while there was no significant difference in the fat grafting group. As for the nipple asymmetry, fat grafting could not correct the asymmetry in both fasciotomy plus fat grafting group and fat grafting group. As for the morphological change after surgery, both nipple and IMF were descended significantly after surgery. The descending range of IMF in the preoperative higher group was larger than the preoperative lower group. On the preoperative IMF higher side, descending degree of IMF was significantly larger in the fasciotomy plus fat grafting group than fat grafting group. CONCLUSIONS: Fat grafting with fasciotomy can improve IMF asymmetry but cannot improve nipple asymmetry. Both IMF and nipple were lowered somehow after surgery, which might be related to the breast enlargement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Upper-Extremity Phlegmasia Cerulea Dolens With Compartment Syndrome in Coronavirus Disease 2019 Sepsis.

A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Her examination result was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention. Instead, we performed bedside fasciotomies and administered therapeutic heparin, and the limb was salvaged. This case underscores the potential for successful limb salvage in patients with phlegmasia in the setting of coronavirus disease 2019 via compartment release and therapeutic anticoagulation.

Closed Incision Negative Pressure Wound Therapy in the Management of a Complex Fasciotomy Wound in a Pediatric Patient.

Acute compartment syndrome (ACS) is a known entity that most often occurs in the setting of trauma in both adult and pediatric patients. Fasciotomy remains the gold standard treatment for relieving intracompartmental pressures but is associated with significant complications. Significant variability exists regarding fasciotomy wound management and closure. We present the only known case report on use of circumferentially applied negative pressure wound therapy instill and dwell (NPWTi-d) followed by circumferentially applied closed incision negative pressure wound therapy (ciNPWT) for the soft tissue management of delayed ACS in a pediatric patient.

Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers.

BACKGROUND: Tuberous breast deformity in the adolescent can be a source of anxiety and social isolation. Current techniques of implant placement and flap reconstruction are not always feasible in this population. OBJECTIVES: The authors evaluated the use of autologous fat grafting with percutaneous fasciotomy and reduction in the nipple-areolar complex for correction of tuberous breast deformity in teenagers. METHODS: A retrospective chart review was conducted for nine teenaged patients with tuberous breast deformity who received autologous fat grafting between January 2016 and December 2018. The recipient site was prepared with the use of percutaneous fasciotomies to release the constricted lower pole of the breast, lowering of the inframammary crease, and reduction in the nipple-areolar complex. Fat was harvested by conventional liposuction prior to injection through three designated sites located at the inframammary fold, anterior axillary line, and upper pole. Complications were recorded. RESULTS: Patients had an average age of 14.9 years at the time of surgery. An average of 1.8 filling sessions were required with a mean of 220 cc of fat injected per breast. Patients were followed for an average of 21 months postoperatively. No serious complications were noted. All patients reported satisfaction with their final outcomes. CONCLUSIONS: Autologous fat grafting in conjunction with percutaneous fasciotomy and reduction in the nipple-areolar complex is a safe and effective treatment of the tuberous breast deformity in teenage patients. It provides an esthetic result with minimal scarring and high satisfaction rates while eliminating the need for flaps or implants. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Secondary surgical and medical treatment of scars]. / Traitement Secondaire chirurgical et médical des cicatrices.

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions.

Surgical Tips for Performing Open Fasciotomies for Chronic Exertional Compartment Syndrome of the Leg.

Chronic exertional compartment syndrome (CECS) of the leg is a debilitating condition that has previously been characterized in athletes and military personnel. The results of surgical management in these patient populations have previously been published with inconsistencies in surgical methods and patient outcomes noted. While endoscopic and minimally invasive techniques have been described, a detailed description of a "standard" open, 2-incision lateral and single-incision medial technique for the treatment of CECS has not been previously published. The purpose of this technique article is to highlight several tips and considerations related to this procedure in the hopes of standardizing treatment and potentially improving patient outcomes. Level of Evidence: Level V, expert opinion.

Breast reconstruction with fat grafting and BRAVA(®) pre-expansion: Efficacy evaluation in 45 cases.

INTRODUCTION: Fat grafting for breast surgery, in reconstruction or aesthetics, gained a lot of popularity over the last years. As an addition to breast reconstruction with flaps or prosthesis, lipofilling improved the aesthetic result, increasing the patients' satisfaction rate. The demand for breast reconstruction using only fat grafting increased, because patients want a natural result in breast reconstruction and also the body contouring associated with liposuction of specified fat areas. The pre-expansion BRAVA(®) system has been used for several years in the United States to prepare the receiving site for lipofilling. We wanted to gain our own experience in associating BRAVA-lipofilling in breast reconstruction. The aim of our study is to evaluate the BRAVA efficiency as an adjuvant for fat grafting in breast surgery. MATERIAL AND METHODS: A retrospective study was undertaken, using a homogenous series of consecutive patients, operated by one surgeon (the first author), that had breast reconstruction using only fat grafts associated with BRAVA(®). RESULTS: The retrospective homogenous study identified 45 cases of breast surgery associating fat grafting alone with BRAVA(®) assistance. The number of intervention of fat grafting associating BRAVA(®) was 1 or 2 for conservative treatment sequelae or for flap reconstruction improvement, and 2 to 4 for immediate and delayed breast reconstruction. The total volume of fat grafting was 205 cc for the contralateral balancing, 317 cc for flap reconstructions, 531 cc for the conservative treatment sequelae, 790 cc for the immediate breast reconstruction and 1165 cc for the delayed breast reconstruction. The satisfaction rate of the surgical team and the patients was satisfying and very satisfied in 82% of cases, average in 8% of cases, and insufficient in 10% of cases. CONCLUSIONS: Breast reconstruction with fat grafting alone is, in our experience, a reliable and reproducible technique, that gives excellent and stable results. The high satisfaction rate of patients is explained by the supple and natural consistency of the new breast, with no added scars, associating the benefits of liposuction of the donor sites. The BRAVA(®) system seems to be, in cases with good indications, an adjuvant for receiving site preparation, making the reconstruction easier for the surgeon and for the patient. We believe that breast reconstruction with fat grafting alone is going to become more popular in the future. Associating fat grafting with BRAVA(®) creates a new way of natural breast reconstruction for the patients with mastectomy that want a stable result with less aggressive procedures. It is a new tool that is going to increase the autologous breast reconstruction in France.

Lipofilling, an efficient solution for breast sequelae after cardiothoracic surgery.

Evolutions in pediatric cardiovascular surgery have allowed the treatment of a various range of cardiovascular malformations in infants. It is a difficult branch of surgery, with vital impact, which can also leave residual thoracic scars, possible sources for thoracomammary deformities in adults. Most thoracomammary deformities after thoracotomy are observed at puberty, when they appear as breast asymmetries. The main cause is the breast bud injured during thoracotomy. Several techniques have been suggested for breast reconstruction, but none give satisfying results. We have been practicing lipofilling since 1998 for breast reconstruction. Since 2001, we have started applying it to breast deformities. The final result is constant in time, natural, and has a good volume filler effect. We describe the fat grafting technique, an original technique, as a solution for this kind of deformities. The technique is illustrated by two clinical cases. In conclusion, fat grafting has really improved breast asymmetry due to iatrogenic deformation. Even if those cases are rare, surgeons have to know this kind of procedure. It is indeed a simple and efficient solution for those patients after childhood, with natural and long standing results.

[How to treat fat necrosis after lipofilling into the breast?]. / Comment gérer les lésions de cytostéatonécrose mammaire après transfert graisseux ?

INTRODUCTION: Fat necrosis is a phenomenon that has been known for a long time in surgery. The fat necrosis is produced because of tissue ischemia and it is also known as cytosteatonecrosis. These lesions can appear with different manifestations: indurations or cysts. Fat necrosis develops in breast aesthetic surgery (breast reduction) or reconstructive breast surgery (after abdominal flaps like TRAM or DIEP). In our department we have been using fat grafting into the breast since 1998 and it has really improved the aesthetic results in breast surgery. Also the fat necrosis lesions can appear after fat grafting, and they should be identified in order to avoid worrying the patient and other doctors that are treating her. The purpose of this article is to present different aspects of fat necrosis after surgery and therapeutic approaches to these problems. MATERIAL AND METHODS: The two authors have noticed the frequency of fat necrosis in the breast after fat grafting into the breast in aesthetic surgery (asymmetry, deformity, lipoaugmentation, improvement of aesthetic sequelae) and reconstructive surgery (after total mastectomy or to improve the aspect of sequelae after conservative surgery). A retrospective study was performed including a homogenous series of consecutive cases that needed breast lipofilling, operated by the two authors. Fat was harvested with cannula after infiltration. The adipose tissue was preparated with a short centrifugation. Fat grafting was realized as backward injections. The tolerance of the performed technique has been studied with the discovery of the fat necrosis lesions after surgery up to one-year follow-up evaluation. RESULTS: Between 1998 and 2013, 2236 fat transfers have been performed by the two authors and were included in a series of consecutive homogenous cases treated by using the same surgical technique. The fat necrosis incidence after lipofilling in the breast shows two frequency curves: the first one with a frequency of 15% (the first 50 cases) and then decreases and stabilizes at about 3%. A second frequency curve appears after 500 cases and fat necrosis has a frequency of 10%. The clinical symptoms are variable. The oil cysts are the most frequent and the earliest manifestation. They can be treated in consultation by punction. The cysts with thick yellow filling and the indurate areas of fat necrosis are rare and can be treated by lipofragmentation using a canula. CONCLUSIONS: The fat necrosis lesion is a classic phenomena, and can be a source of inconveniences for the patients and the surgeons after breast surgery. All the efforts should be directed to avoid fat necrosis. However, fat necrosis is not rare and the surgeon should learn to resolve it without worrying the patient or asking for expensive exams.

[Fat grafting to improve severe tuberous breast]. / Apport du transfert graisseux dans les formes sévères de seins tubéreux.

INTRODUCTION: Tuberous breast is a rare malformation that has major, negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context. Most techniques are based on a combination of skin plasty and mammary gland remodelling, in order to redistribute volumes. Prostheses and local-regional flaps can also be used to correct the missing volume. Fat grafting to the breast has been used in our department since 1998 as a complementary technique in breast reconstruction; it constitutes a natural way of providing volume and modifying the shape of the breast. Since 2000, we have extended this lipomodelling technique to the correction of thorax malformations in general and tuberous breasts in particular. Here, we describe our experience of the correction of severe tuberous breasts by fat grafting. PATIENTS AND METHODS: Over an 11-year period, we performed a retrospective study on tuberous breast patients treated solely with fat grafting (i.e. without using an implant). Each breast deformation was graded according to the Grolleau classification. After aspiration, the fat was centrifuged and then transferred with a specific cannula. Using an 18-G trocar, we sometimes also performed fasioctomies to free up fibrous bridges and mammary gland remodelling. We evaluated the lipofilling for each case (number of sessions and mean fat transfer volume). Technical efficacy was evaluated in terms of patient's satisfaction and the surgeon's opinion. Safety was evaluated by screening for recipient site complications. RESULTS: We performed a retrospective study of 31 cases of tuberous breasts treated between January 2000 and December 2010. The severe tuberous breasts were type 3 in 10 cases. The mean patient age was 21 and the mean body mass index was 21.5. Two session (mean transfer volume: 380 cc) were required in every case. The mean follow-up period after the last fat transfer session was 6 years (range: 1-11). The patients were very satisfied in 90% of cases (n=9) and satisfied in 10% of cases (n=1). No complications were observed. Imaging performed before surgery and one year afterwards did not reveal any anomalies, other than oil cysts. CONCLUSION: The treatment of severe tuberous breast with fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction. The aesthetic outcome is natural, implant-free and long-lasting. Fat grafting decreases local fibrosis and helps (along with fasciotomies and mammary gland remodelling) modify the shape of the breast. The technique corrects the missing volume in a precise, personalized manner. Lipomodelling efficacy and absence of complications have made it our reference treatment for the correction of severe tuberous breasts (as long as the patient has sufficient adipose reserves).

[Percutaneous fasciotomies to improve fat grafting into the breast]. / Fasciotomies percutanées en complément des transferts graisseux: indications en chirurgie du sein.

INTRODUCTION: Breast reconstruction or for breast deformities is a difficult challenge to get excellent results. Lipomodeling technique can improve thoracic malformations and breast deformities. Percutaneous fasciotomies can be an excellent tool for recipient site improvement. The aim of this study is to discuss interest of percutaneous needle fasciotomies with fat grafting into breast surgery. MATERIAL AND METHODS: We have realized a retrospective study with fat transfer into the breast surgery. Recipient site prepared fasciotomies during fat grafting surgical procedure. Fat was harvested and centrifugated. Fat was injected into breast reconstructions or thoracic malformations. We did notice: population (age, BMI, uni/bilateral breasts), surgical procedure (mean sessions number, mean fat transfer). Aesthetic aspects of breasts were rated by both surgeon and patient: skin improvement, volume and shape of breast. Each complication was noticed: tissue wounds, scar evolution, hematoma, infection. RESULTS: We started a retrospective study between 2006 and 2011. One thousand patients were treated with fasciotomies and fat grafting during the same procedure. Main indications were breast reconstruction with latissimus dorsi flap, breast implant reconstruction, breast cancer conservative surgeries, tuberous breast and Poland syndrom. Sessions number expected was between 1 and 3. No complication has been noticed, except 1 tissular wound that needed a medical treatment to solve the problem. CONCLUSION: Fasciotomie is an indispensable complement tool for fat grafting. It is a safe and reliable technique. It improves aesthetic outcomes of breast surgery. Main indications of fasciotomies with fat grafting are breast reconstruction with radiation, breast cancer conservative surgery, and tuberous breast. Percutaneous fasciotomies provide excellent aesthetic result with no scar. They improve the shape of the breast with long-standing result.

Percutaneous fasciotomies and fat grafting: indications for breast surgery.

BACKGROUND: The management of breast deformities can be very difficult in the presence of breast shape retraction. Percutaneous fasciotomies, which release fibrous strings, can be a very useful tool for shape improvement in the recipient site for a fat graft. OBJECTIVES: The authors evaluate the efficacy of fasciotomies in association with fat grafting in breast surgery. METHODS: A retrospective chart review was conducted for 1000 patients treated with concurrent fasciotomies and fat grafting between January 2006 and December 2011. The recipient site was prepared with fasciotomies, and fat was harvested from other parts of the body using a low-pressure 10-mL syringe lipoaspiration system. Fat was centrifuged and injected into the breast for reconstruction or chest deformities. The postoperative appearance of the breast scars was scored by both the surgeon and the patient. Each complication was recorded, including instances of hematoma, infection, tissue wounds, scar healing, and fat necrosis. RESULTS: In this series of patients, for whom the primary indications for the procedure were sequelae of breast-conserving surgery after cancer, latissimus dorsi flap breast reconstruction, breast implant reconstruction, tuberous breast, Poland syndrome, and funnel chest, we recorded the following complications: 0.8% local infections (8/1000), 0.1% delayed wound healing that required medical care (1/1000), and 3% fat necrosis (31/1000). Fasciotomy scarring was considered minor by the patient in 98.5% of cases and by the surgeon in 99% of cases at 1 year postoperatively. CONCLUSIONS: Fat grafting is a safe and reliable technique that improves the aesthetic outcomes of breast surgery. Percutaneous fasciotomies provide excellent aesthetic results and an improvement in breast shape with no scarring. In our experience, both fat grafting and fasciotomies offer a durable result over the long term.

Tuberous breast correction by fat grafting.

INTRODUCTION: Tuberous breast is a rare malformation that has negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context, including a combination of skin plasty and mammary gland remodeling, as well as prostheses and locoregional flaps. The authors have used fat grafting as a complementary technique to correct tuberous breasts since 1998. OBJECTIVES: The authors discuss application of their lipomodeling technique for correction of tuberous breast deformity. METHODS: The charts of tuberous breast patients treated consecutively over an 11-year period (n = 31) solely with fat grafting (ie, without using an implant) were retrospectively reviewed. Each breast deformation was graded according to the Grolleau classification. The number of sessions and the mean transfer of fat volume by lipomodeling session were recorded. Patient and surgeon satisfaction were evaluated. RESULTS: Of the 31 patients in this series, 18 had bilateral formations and 13 had unilateral malformations. The mean patient age was 23 years, and the mean body mass index was 21.9. A single session (mean transfer volume, 158 mL; range, 90-253 mL) was required in 14 (45%) cases. A second session (mean transfer volume, 226 mL; range, 100-316 mL) was necessary in the remaining 55% of cases. Mean follow-up period after the last fat transfer session was 6.5 years (range, 1.5-11 years). Patients were very satisfied in 94% of cases (n = 29) and satisfied in 6% (n = 2). The surgical team rated 94% of cases as being successful or very successful. No complications were observed. One patient developed hypertrophy of the treated breast following weight gain and thus required breast reduction. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts. CONCLUSION: Fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction for the treatment of tuberous breast. The aesthetic outcome is natural, implant free, and long lasting. LEVEL OF EVIDENCE: 4.