title: Feasibility of autologous fat transfer for replacement of implant volume in complicated implant-assisted latissimus dorsi flap breast reconstruction.
abstract: Lipomodeling is gaining popularity and has been widely used in various settings of reconstructive breast surgery. Implant-assisted latissimus dorsi (LD) flap reconstruction of breast is a popular method among the reconstructive surgeons. When this type of reconstruction is met with complications such as infection and capsular contracture, it necessitates removal of implants and patients are left with very limited options of reconstructions. We aim to assess the feasibility of lipomodeling in this setting.Retrospective analysis of prospectively maintained database of 10 patients who underwent lipomodeling to correct the volume deficit after implant removal in patients with implant-assisted LD flaps was carried out. A custom-made questionnaire using a 4-point Likert scale and a visual analog scale was used to assess the patient-reported outcomes. Patients were discharged from care after completion of treatment and were followed up by questionnaire. First questionnaire was sent to assess satisfaction at medium term and the second questionnaire was to assess satisfaction in the longer term.Mean number of sessions were 3 (range, 2-4) and mean duration of treatment was 14 months. Mean duration of initial follow-up was 15 months (range, 3-25 months) and that of longer follow-up was 40 months (range, 19-60 months). Variable amount of fat was harvested and transferred during different sessions. Patients were happy to undergo multiple sessions of fat transfer. No major complications were observed in our series and overall satisfaction was high with a mean score of 9.3 (range, 8-10) in the longer term. Persistence of higher satisfaction during a longer period is reassuring as one of the concerns regarding fat transfer is the unpredictable resorption rate.Lipomodeling is a useful feasible option to replace implant volume in patients with complicated implant-assisted LD reconstruction. Multiple sessions of lipomodeling seem to be acceptable to patients. This technique was associated with negligible complications and high patient satisfaction was maintained during longer periods of follow-up.
authors.affiliation: From the Department of Oncoplastic Breast Surgery, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, United Kingdom.
authors.forename: Dinesh Kumar
authors.initials: DK
authors.lastname: Thekkinkattil
authors.forename: Mohammed
authors.initials: M
authors.lastname: Salhab
authors.forename: Penelope Louise
authors.initials: PL
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057910:Implant Capsular Contracture / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000637:transplantation*; D064171:Superficial Back Muscles / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*