Breast Reconstruction with Fat Grafting Using “Reverse Tissue Expansion”

MATERIALS AND METHODS The technique uses a breast expander following mastectomy, which is then filled regularly until the desired expansion is reached (Fig. 1); the expander is then deflated by approximately 100–150 cc of saline to allow the same or slightly greater amount of purified adipose tissue to be transferred to the mammary region; with an approximately 6-month interval in between sessions; this procedure is repeated until the required volume is reached. The number of surgical sessions depends on the size of the breast to be recreated. Once the expander is fully deflated, we proceed to its removal, followed by the replacement of a quantity of adipose tissue equal to or greater than the volume of the deflated expander ( approximately 60 cc). Fat grafting is performed according to Coleman’s technique and the typical donor areas are the abdomen, flanks, and thighs.1 No infiltration of Klein solution is performed so as to minimize cell damage. Fat is harvested using a 10-cc luer-lock syringe connected to a 3-mm Coleman blunt tip cannula under a slightly negative pressure. Centrifugation is performed at 3,000 rpm for 4 minutes, and the refined fat is then transferred into 3 cc syringes. Retrograde injections of small aliquots of fat (1 cc) are needed to create a 3D structure, which facilitates the adherence between the fat itself and the vascularized surface and, therefore, the engraftment rate.2–4 The selection criteria for this type of