Breast reconstruction (either prophylactic because of genetic predispositionor after mastectomy for breast cancer) is performed with implants or autologous (the patient’s own) tissue. Implants are foreign material and induce scarring or capsule formation. Breast reconstruction with autologous tissue is the standard approach because the breast is reconstructed with the patient’s own tissue; the result is a very natural looking breast with a stable result at the long-term. Autologous tissue transfer involves microsurgical repair of the blood vessels and the creation of an additional scar somewhere else in the body (where tissue is removed to reconstruct the breast).
The standard approach is autologous, microsurgical tissue transfer. It requires expertise in microsurgery. Skin and subcutaneous tissue is removed from the abdomen, back or buttock area and transplanted to the breast region. Blood flow is repaired with microsurgery.
Tissue can be removed from:
- abdomen = DIEP flap
- buttock or gluteal = SGAP flap
- lower back = LAP flap (lumbar flap)
Breast reconstruction with lipofilling is only indicated in very specific cases: patients that are no candidate for microsurgical tissue reconstruction and only require a small volume breast. Fat removed with liposuction and used for lipofilling is a “liquified” material. With this liquified material it is very challenging to reconstruct a breast because a breast has a specific shape, volume (distribution) and projection. It is not possible to reconstruct a breast with one session of lipofilling. Often three, four or even more sessions are necessary to reconstruct a moderate volume (200 cc).
It is very important that this is well discussed at the outpatient clinic and the patient needs to be motivated to undergo several sessions of lipofilling. The procedures are done under general anesthesia and in day clinic admission.
We follow a specific strategy that has been published in the Journal of Plastic, Reconstructive and Aesthetic Surgery (JPRAS). To open a copy of our manuscript please click here.