Refined Method of Lipofilling following DIEP Breast Reconstruction: 3D Analysis of Graft Survival

BACKGROUND The deep inferior epigastric perforator (DIEP) flap technique gives good clinical results, but aesthetic surgical adjustments are often necessary. Lipofilling represents a good complementary method, but fat resorption within the few months after surgery limits its use. Recently, a new protocol was introduced and successfully evaluated on murine models. This study aims to evaluate this protocol following a DIEP procedure by three-dimensional analysis. METHODS Within a period of 4 months, every patient having undergone breast reconstruction with DIEP and who required a lipofilling adjustment was invited to take part in this study. All surgeries were performed using the Adip'sculpt disposable medical device MACROFILL (Laboratoires SEBBIN, Boissy-l'Aillerie, France). Fat resorption was analyzed using a three-dimensional photography system. RESULTS Twenty-three patients were included, with a total of 25 breasts operated on. Injections were carried out on irradiated breasts in 73% of cases, and average injection volume was 124 mL (SD = 39 mL), whereas average operating time was 68 minutes (44-96 minutes). At an average follow-up of 5 months (4-8 months), 70.9% of projection gain afforded by the lipofilling was still present. CONCLUSIONS It is now clear that particular rules should be respected for an efficient lipofilling, particularly regarding aspiration cannula characteristics, vacuum used, and the necessity of washes and soft centrifugations. We demonstrate here that by following a specific protocol that addresses these precautions, while using material that is specifically adapted, a 70.9% fat survival rate can be achieved, even in the very unfavorable case of postirradiation DIEP breast reconstruction.