title: Intratissular expansion-mediated, serial fat grafting: A step-by-step working algorithm to achieve 3D biological harmony in autologous breast reconstruction.
abstract: BACKGROUND
  Breast reconstruction involves the use of autologous tissues or implants. Occasionally, microsurgical reconstruction is not an option because of insufficient donor tissues. Fat grafting has become increasingly popular in breast surgery. The challenge with this technique is how to reconstruct a stable and living "scaffold" that resembles a breast.
  
  
  METHODS
  Breast reconstruction (n = 7) was performed using intratissular expansion with serial deflation-lipofilling sessions. Mean age of the patients was 41 years (22-53). The expander generated a vascularized capsule at 8 weeks, which demarcated a recipient site between the skin and the capsule itself, and functioned as a vascular source for angiogenesis. Serial sessions of deflation and lipofilling were initiated at 8 weeks with removal of the expander at the completion of the treatment. An average of 644 ml (range, 415 ml-950 ml) of lipoaspirate material was injected to reconstruct the breast mound. An average of 4 (range, 3 to 5) fat-grafting sessions with a 3-month interval was needed to achieve symmetry with the contralateral breast. The average follow-up was 14 months (range, 9-29 months). MRI examination was performed at 8 months to analyze tissue survival and the residual volume.
  
  
  RESULTS
  MRI examination retained tissue survival and the mean reconstructed breast volume was 386 ml (range, 231 ml-557 ml). An aesthetically pleasant breast mound was created, with a high satisfaction rate.
  
  
  CONCLUSIONS
  We could reconstruct an aesthetically pleasant and stable breast mound in a selected group of patients by using intratissular expansion and fat grafting.
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium. Electronic address: filip.stillaert@ugent.be.
authors: Filip B J L
authors: FB
authors: Stillaert
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium.
authors: Casper
authors: C
authors: Sommeling
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium.
authors: Salvatore
authors: S
authors: D'Arpa
authors: Department of Pathology, University Hospital Ghent, Belgium.
authors: David
authors: D
authors: Creytens
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium.
authors: Koenraad
authors: K
authors: Van Landuyt
authors: Department of Gynecology, University Hospital Ghent, Belgium.
authors: Herman
authors: H
authors: Depypere
authors: Department of Gynecology, University Hospital Ghent, Belgium.
authors: Rudy
authors: R
authors: Van den Broecke
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium.
authors: Stan
authors: S
authors: Monstrey
authors: Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Belgium.
authors: Phillip N
authors: PN
authors: Blondeel
authors: O'Brien Institute, Melbourne, Australia.
authors: Wayne A
authors: WA
authors: Morrison
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000465:Algorithms; D001530:Belgium; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D017060:Patient Satisfaction; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods; D014022:Tissue Survival; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
keywords: Autologous; Breast reconstruction; Lipofilling; Tissue expansion