title: Breast reconstruction de novo by water-jet assisted autologous fat grafting--a retrospective study.
abstract: BACKGROUND
  Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone.
  
  
  METHODS
  A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.4 years). All women were treated with the water-jet assisted fat grafting method (BEAULI™) combined with additional procedures (NAC reconstruction, contralateral mastoplasty) and evaluated with at least 6 months follow-up (mean 2.6 years). Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale) and digital photographs were carried out.
  
  
  RESULTS
  On average the patients received 4 to 6 procedures each with a single volume of 159 ml (±61 ml) over 21 months (range 9 months to 2.5 years). In total 1,020 ml (±515 ml) fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041). Main treatment complications were liponecrosis (2.59%), infection (0.74%) and granuloma (0.74%). Patient satisfaction was overall high to very high (96%) and confirmed the good aesthetic results (68%) and the natural softness, contour and shape of the reconstructed breast.
  
  
  CONCLUSIONS
  A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.
authors.affiliation: BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany.
authors.forename: Delia Letizia
authors.initials: DL
authors.lastname: Hoppe
authors.affiliation: Parkklinik Birkenwerder, Birkenwerder, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Ueberreiter
authors.affiliation: Clinique Saint Antoine, Rouen University Hospital, Paediatric and Dermatologic Plastic Surgery, Bois Guillaume, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Surlemont
authors.affiliation: Plastic Surgery Hospital KL, Helsinki, Finland.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Peltoniemi
authors.affiliation: Azienda Sanitaria di Piacenza, Cremona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Stabile
authors.affiliation: Helsinki University Hospital, Department of Plastic and Reconstructive Surgery, Helsinki, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Kauhanen
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation* / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: autologous fat grafting; breast reconstruction; lipotransfer; mastectomy