Breast Reconstruction Using A Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Using Tissue Engineering Principles
Mark A. Schusterman, MD1, Robert D. Rehnke, MD2, John M. Clarke, MD3, Brent Price, MD4, Uzma Waheed, MD5, Richard Debski, PhD6, Stephen F. Badylak, MD, PhD6, J. Peter Rubin, MD1.
1UPMC, Pittsburgh, PA, USA, 2Robert D. Rehnke Plastic Surgery, St. Petersburg, FL, USA, 3Palms Surgical Associates, St. Petersburg, FL, USA, 4Price Hoffman Stone Associates, Saint Petersburg, FL, USA, 5UPMC Department of Radiology, Pittsburgh, PA, USA, 6University of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: Breast reconstruction remains an important field in plastic surgery, with most procedures utilizing implants and/or autologous tissue. Few series report on experience with fat grafting as the primary form of breast reconstruction. This study reports a new method of breast reconstruction using a three-dimensional absorbable mesh scaffold and subsequent AFG.
METHODS: A retrospective review was performed for all patients who underwent breast reconstruction using a three-dimensional absorbable mesh, or "Lotus", scaffold with subsequent AFG. Three different mesh products were utilized: TIGR, SERI, and Phasix mesh. Multiple data points were collected, including patient demographics, cancer details, surgical details, post-operative results and complications. Post-operative mammogram and MRI were analyzed by multiple radiologists at different centers. Specimens of mesh and surrounding fat were collected at subsequent procedures and stained with H&E for histological evaluation. Lastly, compression testing of the scaffold was performed using a tensiometer and digital motion tracking technology.
RESULTS: 11 patients underwent reconstruction of 14 breasts using Lotus scaffold and AFG between February 2015 and February 2017. Average follow-up was 14 months. All patients were satisfied with final breast shape and size. Mean patient age was 60.5 years and average BMI was 29.1. Patients required on average 2 fat grafting sessions to achieve a successful result (range 1-4). The most frequently utilized mesh was Phasix. Post-operative mammogram and MRI revealed robust adipose tissue in the breast with a slowly resorbing mesh and no oil cysts or calcifications. Histological evaluated revealed no capsule formation with ingrowth of fat tissue around the scaffold. This was most apparent in specimens with Phasix mesh. There was also minimal inflammatory response surrounding the Phasix mesh with a more robust inflammatory response around the TIGR mesh. Compression testing revealed that the Lotus scaffold is a compliant construct with a high resilience profile. The permanent deformation of the scaffold after 10 cycles of 80% compression was only 2 millimeters, or approximately 4% of the height of the scaffold.
CONCLUSIONS: The Lotus scaffold with AFG is a viable method for breast reconstruction, giving the patient an autologous reconstruction with less morbidity compared to free tissue transfer.
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