BACKGROUND: Breast reconstruction following prophylactic mastectomy in women with ptotic or hypertrophic breasts often poses challenges. We describe a combined technique of large-volume fat grafting (>100 mL) and an inferior dermal flap, aiming to improve aesthetic outcomes and patient satisfaction. METHODS: We conducted a retrospective analysis of 21 patients undergoing immediate breast reconstruction with the described technique. All patients were asked to complete the BREAST-Q questionnaire preoperatively and at least 12 months postoperatively (median interval: 20 months). Statistical analysis (Wilcoxon signed-rank test) was used to assess changes in satisfaction and well-being; aesthetic outcomes were scored by an independent, multidisciplinary team. RESULTS: Among 13 patients with complete BREAST-Q data, satisfaction with the breasts increased significantly from a median score of 38-85 (p = 0.002), psychosocial well-being from 57-70 (p = 0.045), and physical well-being (chest) from 68 to 81 (p = 0.045). Sexual well-being rose from 47-63 (p = 0.023). Aesthetic evaluation by an independent panel showed notable improvements in breast symmetry, shape, and overall appearance. Minimal and asymptomatic fat necroses or oil liponecrotic pseudocysts were observed. CONCLUSIONS: Combining large-volume fat grafting with an inferior dermal flap appears promising for women with ptotic breasts, yielding high satisfaction and low complication rates. Despite requiring multiple operative stages, this autologous reconstruction technique may offer a less invasive alternative for high-risk patients seeking natural outcomes without implants.
- MeSH
- Surgical Flaps * MeSH
- Adult MeSH
- Esthetics MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Mammaplasty * methods MeSH
- Breast Neoplasms * prevention & control surgery MeSH
- Prophylactic Mastectomy * MeSH
- Breast surgery pathology MeSH
- Surveys and Questionnaires MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Patient Satisfaction MeSH
- Adipose Tissue * transplantation MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Surgical Procedures, Operative methods MeSH
- Conservative Treatment MeSH
- Humans MeSH
- Orthopedic Procedures methods MeSH
- Postoperative Care methods MeSH
- Arm Injuries surgery physiopathology therapy MeSH
- Finger Injuries surgery physiopathology therapy MeSH
- Hand Injuries * surgery physiopathology therapy MeSH
- Tendon Injuries * surgery physiopathology therapy MeSH
- Fingers physiopathology MeSH
- Hand anatomy & histology physiopathology MeSH
- Tendons physiopathology MeSH
- Physical Therapy Modalities MeSH
- Hand Deformities, Acquired physiopathology therapy MeSH
- Check Tag
- Humans MeSH
- MeSH
- Autografts transplantation MeSH
- Surgical Flaps transplantation MeSH
- Surgical Procedures, Operative methods MeSH
- Fractures, Bone surgery therapy MeSH
- Integumentary System surgery MeSH
- Humans MeSH
- Osteomyelitis therapy MeSH
- Leg Injuries surgery therapy MeSH
- Soft Tissue Injuries surgery therapy MeSH
- Negative-Pressure Wound Therapy methods MeSH
- Skin Transplantation methods MeSH
- Accidents MeSH
- Plastic Surgery Procedures * methods MeSH
- Check Tag
- Humans MeSH
Vrozené vývojové vady prsu spojené s výraznou hypoplazií až aplazií nebo tvarovou deformitou prsu mohou mít nepříznivý vliv na osobní i společenský život dospívajících dívek. Chirurgická korekce vady může pacientkám pomoci zbavit se pocitu méněcennosti a rozvíjet tak zdravé sociální vazby v kolektivu. Rekonstrukce prsu vlastní tkání pomocí tzv. lalokových plastik je zatížena morbiditou v oblasti odběrového místa. Mezi hlavní nevýhody rekonstrukce prsu pomocí silikonových implantátů patří omezené možnosti tvarování prsu a posunu atypicky umístěného dvorce a nutnost výměn implantátů v pozdějším věku pacientky. Lipomodelace prsu je miniinvazivní chirurgická technika přenosu tukové tkáně formou lipoinjekcí, pomocí které lze rekonstruovat etapovitě prs přirozené konzistence a dosáhnout vysokého stupně symetrie. Vzhledem k tomu, že se prs vytváří postupně, tak je možné s rekonstrukcí začít v rané adolescenci a zabránit tak negativnímu vlivu vady na duševní a sociální vývoj dívek. Cílem práce je představit na základě odborné literatury a našich klinických zkušeností využití techniky lipomodelace v rekonstrukci prsu u pacientek s Polandovým syndromem a tuberózní deformitou prsu.
Congenital breast malformations such as a major hypoplasia or even breast aplasia and considerable breast shape deformities can have a negative impact on women's personal or social life during adolescent age. Surgical correction may help these patients to increase their self-esteem and to build normal relationships. Autologous breast reconstruction using tissue transfers, known as flaps, is associated with scars and possible donor site morbidity. Main disadvantages of breast reconstruction with implants are limited options for breast-shaping and difficult relocation of atypically placed areola. The need for replacement of breast implants later in patient's life represents another disadvantage. Breast lipomodelling is miniinvasive surgical technique of fat tissue transfer by lipoinjections, which is used to form volume of the breast in several sessions, having natural consistence and reaching a high degree of symmetry. Due to gradual formation of the breast, it is possible to start correction of malformation in early adolescence, and to prevent negative effect of malformation on mental and social development of a young person. The aim of this paper, based on literature review and our clinic experiences, is to present the use of lipomodelling technique in breast reconstruction in cases of Poland's syndrome and tuberous breast deformity.
- Keywords
- tuberózní deformita prsu,
- MeSH
- Transplantation, Autologous * methods MeSH
- Adult MeSH
- Fasciotomy MeSH
- Quality of Life MeSH
- Humans MeSH
- Lipectomy methods MeSH
- Mammaplasty methods MeSH
- Minimally Invasive Surgical Procedures MeSH
- Adolescent MeSH
- Tissue and Organ Harvesting methods MeSH
- Poland Syndrome surgery therapy MeSH
- Breast * abnormalities MeSH
- Adipose Tissue transplantation MeSH
- Congenital Abnormalities MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Adolescent MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: Lipomodeling is a technique that uses the patient's own fat for tissue regeneration and augmentation. The extent of regenerative effect is reported to be determined by the numbers of adipose-derived stem cells and the viability of cells in processed adipose tissue which, together with other factors, influence the degree of graft retention. This study addresses whether differences exist in properties of fat graft obtained by three commonly used techniques. METHODS: Adipose tissue harvested from the hypogastric regions of 14 patients was processed by decantation, centrifugation, and membrane-based tissue filtration. The morphology of each preparation was assessed by electron microscopy and overall cell viability was assessed by live/dead assay. The number of adipose-derived stem cells was determined and their stem cell character was assessed by the presence of cell surface molecules (i.e., CD105, CD90, CD31, and CD45) and by their capacity to differentiate into adipogenic and osteogenic lineages. RESULTS: First, morphologies of processed fat samples obtained by individual procedures differed, but no preparation caused obvious damage to cellular or acellular components. Second, although the highest numbers of adipose-derived stem cells were contained in the upper fraction of centrifuged lipoaspirates, the difference between preparations was marginal. Third, the maximal concentration of adipose fraction (removal of watery component) of lipoaspirate was achieved by membrane-based tissue filtration. Finally, no significant differences in overall viability were detected. CONCLUSIONS: Properties of processed lipoaspirate were influenced by the preparation procedure. However, the differences were not dramatic; both centrifugation and membrane-based filtration are methods of choice whose selection depends on other criteria (e.g., practicality) for individual surgical settings.
- MeSH
- Cytological Techniques MeSH
- Adult MeSH
- Stem Cells MeSH
- Cells, Cultured MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Tissue and Organ Harvesting methods MeSH
- Adipose Tissue transplantation MeSH
- Adipocytes MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
