Tissue Engineering A Breast Mound by External Expansion & Autologous Fat Grafting

Publisher: Miami Breast Center

Purpose: Tissue engineered organs consist of sophisticated implanted biocompatible scaffolds seeded with the appropriate cells. To tissue engineer a breast mound, we generated in-situ the necessary scaffold by externally expanding the mastectomy defect and seeded it with lipoaspirate. We hereby report on our three-years multicenter clinical experience with this patient friendly method of autologous breast reconstruction.

Methods: We reconstructed 33 women who were 0d- 30y post-mastectomy (47 breasts, 14 radiated). They wore the BRAVA external expander 10 hrs/d for 10-30 days prior to the first grafting. Expansion was considered adequate when the mastectomy scars stretched to create a 200-300 ml recipient matrix. We grafted 150-600 ml of fat suspension per breast per grafting session. One week post-transfer, they resumed use of the expander for 10 hrs/d till the next lipografting session. 2-5 outpatient procedures spaced 6-16 weeks apart were required till the surgeon and the patient were satisfied with the breast volume and shape. Follow up MRI and mammograms were obtained.

Results: Six months after the last graft, final stable breast volume ranged from 300-600 ml. The breasts were soft, sensate, and had aesthetically pleasing shapes. Mammographies were read as normal fatty breasts and MRI revealed well-vascularized fat with a few scattered benign oil cysts. Complications included a swiftly treated pneumothorax and a few transient cysts. All patients were highly satisfied with their reconstructed breasts and thankful for the body sculpturing byproduct. No new scars were added and the original mastectomy scars were markedly improved.

Conclusion: We describe a paradigm shift in breast reconstruction. By combining serial lipografting with external expansion we achieved, with very few minimally invasive grafting procedures, the equivalent of an autologous flap breast reconstruction. External expansion created a skin envelope, stretched the scar & generated a fertile recipient matrix for large lipograft volumes. This method of breast reconstruction promises to supplant the current alternatives.

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