Fat Graft Only Breast Reconstruction With and Without Buried Dermatocutaneous Flaps: A minimally invasive approach
Boris E. Goldman, MD1, Zandra HM Cheng, MD2, Jeanne S. Capasse, MD1.
1Nuvance Health, Norwalk, CT, USA, 2Nuvance Health, Danbury, CT, USA.
AbstractBackground: Autologous breast reconstruction historically required flaps that were invasive, required prolonged operative times and recoveries, and resulted in varying degrees of donor site morbidity. We present a minimally invasive autologous breast reconstruction technique utilizing fat grafting with and without buried folded over dermato-cutaneous Wise pattern flaps. This is a single Plastic Surgeon, consecutive case series.Methods: Patients desiring autologous breast reconstruction that had sufficient breast ptosis and fat donor tissue were offered breast reconstruction with buried folded over Dermato-Cutaneous flaps with Adipocyte Transfer (DCAT). For DCAT, a Wise pattern mastectomy was performed, and fat transferred into an inferiorly based, folded over buried dermato-cutaneous flap. Fat was also immediately grafted into the pectoral, sub pectoral, and serratus sub-fascial planes. For those with minimal breast ptosis, fat graft only reconstruction was performed at the time of mastectomy. Patients underwent an average of two (range 0-3) additional fat graft sessions at 3-month intervals to complete the reconstruction.Results: 47 consecutive patients (78 breasts) underwent fat graft only reconstruction (48 breasts DCAT, 30 breasts Fat Graft Only); with 28 (36%) free nipple grafts. Ten patients (10 breasts) had prior breast radiation, and four patients (4 breasts) required post mastectomy radiation. Fat grafted at initial mastectomy was 86 ml per breast (range 35-175 ml). On average, two additional outpatient fat graft sessions (range 0-3) at 3-month intervals completed the reconstruction. Average fat grafted at second stage was 208 ml (range 50-330 ml). Average follow up was 19 months from initial fat graft, and 10 months from last fat graft. Three patients had partial skin flap necrosis of one breast each that healed with local wound care. In all three of these cases, the area of necrosis involved the vertical limb near the “T” portion of the Wise pattern closure. While ten patients (10 breasts) in this consecutive case series had prior breast radiation, the authors do not recommend that Surgeons new to the DCAT procedure offer it to this subset of patients. Radiated patients present additional challenges due to varying degrees of mastectomy skin flap contracture. Conclusions: The authors present their experience with a minimally invasive autologous breast reconstruction technique that does not require microsurgery, external expanders, or prolonged operative times. This single Plastic Surgeon consecutive case series is the largest reported series to date utilizing buried fat grafted dermatocutaneous flaps. 
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