Scarless Composite Breast Reconstruction Utilizing an Advancement Skin Flap, Loops, and Lipofilling

[Update and Trends in Breast Reconstruction After Mastectomy]

Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.

A Novel Approach for Tuberous Breast Correction Using Power-Assisted Liposuction, Loops, and Lipofilling (PALLL)

BACKGROUND

Autologous fat grafting has recently gained popularity in breast and reconstructive procedures.

OBJECTIVES

The aim of this paper was to describe a tricomposite tuberous breast reconstruction that comprises matrix dissociation through extensive tunnelization, tissue recruitment with loops, and autologous fat transfer. This approach, called "matrix modeling," was implemented by the power-assisted liposuction, loops, and lipofilling (PALLL) technique as a method to expand the lower pole, reshape the breast, and increase breast volume.

METHODS

Between 2014 and 2020, a total of 47 patients underwent tuberous breast correction by combined lipofilling and the use of breast loops. The patient population included patients with unilateral or bilateral tuberous breasts of any stage. Patients who were active smokers, lean, or who desired large breasts were excluded from the study.

RESULTS

Of the 47 patients (mean age, 26 years), 31 had bilateral malformations. The mean recruited flap volume was 212 mL. A single session (mean transfer volume, 163 mL) was required in 34 cases (72%). A second session (mean transfer volume, 182 mL) was necessary in the remaining 28% of cases. Patients were very satisfied in 93% of cases and satisfied in 7% of cases. One infection was observed. The mean operative time was 67 minutes. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts (4%).

CONCLUSIONS

Tricomposite breast reconstruction by PALLL is a novel, simple, safe, and alternative technique for tuberous breast correction by remodeling the matrix. The aesthetic outcome is natural, implant free, and long lasting.

LEVEL OF EVIDENCE: 4