Full breast reconstruction with fat and how to recycle the "dog-ear"

Mastectomy without immediate reconstruction leaves us with a population of women who may need a new breast in a delayed fashion. These women are often elderly, not fit for major flap surgery or reluctant to have long scars or implants. Free fat grafting has mainly been used as an adjunct to other reconstructive methods. We present an option for delayed full breast reconstruction with free fat grafting alone. In some cases, we utilize the lateral excess as a flap in combination with fat grafting. Patient selection is crucial. A lady fitting this reconstruction method should have fat to donate, preferably in several different regions as well as redundant skin on the chest-wall and only minor radiation damage. Also, breast size requirements need to be sensible. The Fat is harvested in a closed system under general or local anesthesia. Following a few minutes decantation, the fat is put into syringes and injected from 4-6 entrance points into 3-4 layers with a blunt cannula. Depending on the width, height and thickness of the receiving chest wall, the transferred volume varies between 150-300 cc/operation. In general, 2-5 operations are needed to reconstruct a breast with fat alone. If the patient presents with lateral excess tissue, this can be utilized as a local, fasciocutaneous flap, de-epithelialized and rotated 180 degrees to support the inferior border of the new breast. This enables inferolateral definition and control of the breast footprint. The secret behind success in free fat grafting for full breast reconstruction lies in the small technical details and works safely and efficiently in a selected group of patients.