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Composite Breast Reconstruction: The Use of Micro Fat Grafting As An Adjunct To Standard Reconstructive Techniques
Boris E. Goldman, MD.
Aesthetic Plastic Surgery Center, Westport, CT, USA.

Background: Micro fat grafting is increasingly being used as an adjunct to standard breast reconstruction techniques; including expander/implant and autogenous reconstruction. The author presents a composite breast reconstruction technique utilizing micro-fat grafting coupled with implants and either autogenous muscle (latissimus) or Acellular Dermal Matrix (ADM). In the authorís experience, it is possible to achieve more aesthetic results with a composite technique than with either an implant or muscle flap technique alone.
Purpose: To present a simple and effective method of breast reconstruction using a composite technique incorporating the use of implants, micro fat grafts, and muscle or ADM. The same micro-fat graft technique has also been applied for correction of post lumpectomy/radiation breast deformities.
Results: The author has been performing micro fat breast reconstruction as an adjunct to standard breast reconstruction techniques and for post lumpectomy/radiation deformities for the last 3 years. To date a total of 43 cases has been performed. The procedure has been extremely well tolerated, with minimal to no morbidity; 2 patients required local excision of fat oil cysts.
Conclusion: Utilizing a simple technique for fat harvest and preparation, micro fat grafting was performed for patients with post lumpectomy/radiation deformities and in post mastectomy breast reconstruction deformities. The author presents technical pearls for the procedure as well as photos documenting before and after results.

Figure 1: Post-op left latissimus flap and implant before fat grafting.

Figure 2: Post-op left latissimus flap and implant, with post-op fat grafting (multiple sessions) and nipple reconstruction.

Figure 3: Post-Op right latissimus/implant/fat graft reconstruction

Figure 4: Post-Op right lumpectomy/radiation, and Pre-Op Mastectomy.

Figure 5: Post-op bilateral mastectomy implant/ADM reconstruction and micro fat grafting

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