title: Dermal fat graft from simultaneous abdominoplasty as an adjunct to revision aesthetic and reconstructive breast surgery: A poor man's acellular dermal matrix?
abstract: BACKGROUND
  The global use of acellular dermal matrices as an adjunct to tissue expander or implant-based breast reconstruction, by surgeons wishing to cover and support the inferior breast pole, has increased in frequency in the last two decades. However despite the reported enhanced cosmetic outcomes, issues regarding their cost effectiveness have led to their infrequent use within the UK National Health Service and the need for an equally efficacious but cheaper alternative.
  
  
  METHODS
  We report two patients requiring bilateral revision breast surgery for severely asymmetrical, tender, ptotic breasts and cosmetically poor abdomens. Both were denied assisted acellular dermal matrix reconstructive surgery on the state NHS system and unable to afford the private costs. We therefore utilised free dermal fat grafts, harvested from concomitant abdominoplasties to extend the pectoralis major muscle and smoothen surface irregularities.
  
  
  CONCLUSIONS
  Both patients achieved excellent cosmetic outcomes and aside from a small, spontaneously resolving abdominal site seroma in one patient, have remained free of any complications for over two years. This cost effective procedure is only feasible in patients with an adequate pannus who are amenable to the extra surgery and resultant scarring.
  
  
  CONCLUSIONS
  We herein report the use of free dermal fat graft in revision aesthetic and reconstructive surgery in a manner akin to recent acellular dermal matrix use. The comparable enhanced aesthetic outcomes, minimal complication rate and substantial cost savings merit dissemination to a global audience and encourage surgeons to consider this economic alternative.
authors.affiliation: University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: F
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Plastic & Reconstructive Surgery at Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: W M
authors.initials: WM
authors.lastname: Nabulyato
authors.affiliation: Department of Plastic & Reconstructive Surgery at Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cambridge Breast Unit at Addenbrooke's Hospital, Cambridge, UK; Anglia Ruskin University Postgraduate Medical Institute, Cambridge & Chelmsford, UK. Electronic address: cmalata@hotmail.com.
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
keywords: Abdominoplasty; Acellular dermal matrix (strattice; Breast implants; Capsulectomy; Dermal fat graft; Health economics; Implant exchange; Periareolar breast implant surgery; Revision breast implant surgery; alloderm)