title: Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery.
abstract: OBJECTIVE
  The objective of this article is to report our findings regarding large-volume fat transfer in patients who have undergone autologous breast reconstruction with the latissimus dorsi (LD) flap and/or implant-based reconstruction with subsequent lipomodelling for symmetrisation.
  
  
  METHODS
  We retrospectively collected data on all patients who have undergone lipomodelling from October 2008 to October 2011. Fat was harvested using a low-negative pressure syringe method and centrifuged at 3000 r.p.m. for 3 min. The purified fat was injected in 1 mL increments into multilayered microtunnels, starting from deeper layers and moving to superficial layers in the subcutaneous tissue. Patient satisfaction was assessed using validated Picker questions in a face-to-face consultation during follow-up visits, and the results were documented in the case notes.
  
  
  RESULTS
  Thirty-one patients underwent lipomodelling following autologous breast reconstruction using the LD flap and implant-based reconstruction. Three patients in the study group had bilateral lipomodelling, and one patient required 3 lipomodelling sessions. Seven patients required 2 sessions, and 21 patients required a single session to achieve bilateral symmetry. The mean volume of fat that was harvested was 396 mL, and the mean injected volume of fat was 247 mL. Four patients (1 breast cancer recurrence, 2 patients with fat necrosis and 1 patient with oil cysts) developed postoperative complications. Twenty-nine patients (93%) were satisfied with the postoperative cosmetic outcome.
  
  
  CONCLUSIONS
  Lipomodelling offers an additional tool to refine breast reconstructive surgery. This study demonstrates that large volumes of fat can be injected for sculpture optimisation and for reshaping reconstructed breasts with improved softness and a natural feel.
authors.affiliation: Department of Breast and Oncoplastic Surgery, West Sussex Breast Centre, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, United Kingdom. Electronic address: riccardo.bonomi@whst.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Bonomi
authors.forename: D
authors.initials: D
authors.lastname: Betal
authors.forename: I F
authors.initials: IF
authors.lastname: Rapisarda
authors.forename: L
authors.initials: L
authors.lastname: Kalra
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: A
authors.initials: A
authors.lastname: Johri
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Autologous fat injection; Breast reconstructive surgery; Lipomodelling