Autologous Fat Grafting at the Time of Reduction Mammoplasty for Resolution of Shoulder Groove Deformity
Alap U. Patel, BA, Hannah M. Smith, MD, Paige L. Myers, MD, Ashley N. Amalfi, MD.
University of Rochester Medical Center, Rochester, NY, USA.
BACKGROUND: In women with macromastia, the significant weight carried in the brassiere is translated to the brassiere strap where it crosses over the shoulder. Over time, this tension can lead to a soft tissue defect, commonly recognized as shoulder grooving, which is reportedly painful and uncomfortable for patients. While reduction mammoplasty addresses the development of further shoulder grooving by reducing the weight of the breast, it often does not resolve a significant/severe shoulder groove deformity. Surgical outcomes and patient-reported satisfaction after the novel use of fat grafting for shoulder groove deformity were studied. METHODS: This is a retrospective review of 22 patients undergoing breast reduction surgery with autologous fat grafting into shoulder grooves over a 3-year period at an academic plastic surgery practices. Patients were contacted following their procedure to evaluate long-term satisfaction. Data regarding cost were obtained from the billing office. RESULTS: Patient demographics revealed a mean age of 46.6 years (SD 15) and a BMI of 30.0 (SD 4.7). Breast reduction skin excisions were done via a wise pattern (77%) or vertical (23%). Pedicles were inferior (55%) or superiomedial (45%). A mean of 588 g (SD 341) was removed from each breast. The mean amount of fat injected into each shoulder groove was 28.8 g (SD 7.1). In all instances, fat was harvested from the lateral chest wall/axilla; an average of 288 cc (SD 129) of fat was harvested. No patients had complications related to their fat grafting donor or recipient sites. One patient experienced a breast seroma drained in clinic. Post-operatively, all patients reported a clinical improvement in their painful shoulder grooves upon when directly asked. All patients reported satisfaction with the fit and comfort of their bras. No patients experienced painful or recurrent shoulder grooving. In general, patients were eager to share their positive experience with fat grafting to their shoulder grooves, and many were grateful to have been offered this adjunct procedure All patients had prior authorization for both the breast reduction and shoulder fat grafting procedures. CONCLUSIONS: Autologous fat grafting of shoulder groove deformity at the time of reduction mammoplasty is a safe procedure generally covered by insurance, with low morbidity and a high level of functional and aesthetic patient satisfaction.
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