Correction of Secondary Chest Wall/ Reconstructed Breast Deformity with Micro Fat Grafting

 Micro Fat Grafting is a technique utilized to add volume in an area where a deficit occurs in addition to helping in rejuvenation and restore damages caused by radiation. This procedure utilizes the patient’s own fat that is harvested through manual micro liposuction techniques. The micro fat grafts are removed, centrifused, cleansed, and reinjected into the patient where the deficit exists. Common areas that this procedure targets are the face, hands, breast, and buttock.

Often times, following a mastectomy, the patient is left with a deficit in the upper chest wall. Resulting from this the patient is left with a lack of cleavage or sometimes even a sunken appearance to the upper chest. Utilizing fat grafting, these deficits can be filled out, and the patient is left with a more natural contour.

Case: This patient is a 51 year old female who presented with displeasure with her chest wall deformity “concavity” following a pedicled TRAM flap reconstruction and a mastectomy done elsewhere. After a thorough evaluation and physical examination, I agreed that an improvement could be accomplished. My surgical advice was to utilize micro fat grafting techniques to add volume to the upper chest wall, and revise the placement of the current TRAM flap in an effort to aesthetically improve and naturalize the appearance of the reconstructed breast.

Surgery: I elected to use the abdomen and flanks as the donor site for the micro fat graft harvest sites. With the use of micro fat grafting cannulas, a reintroduction of approximately 280 cc of micro fat grafts to the upper chest wall in a three dimensional fashion to maximize the contact of the grafts with healthy vascularized tissue. This specific cutting edge technique will aid with higher percentage of permanent graft retention. Revision of the pedicled TRAM flap to improve outcome was done as well.

 Micro Fat Grafting is a technique utilized to add volume in an area where a deficit occurs in addition to helping in rejuvenation and restore damages caused by radiation. This procedure utilizes the patient’s own fat that is harvested through manual micro liposuction techniques. The micro fat is removed, centrifused and  cleansed, and reinjected into the patient where the deficit exists. Common areas that this procedure targets are the face, hands, breast, and buttock.

Often times, following a mastectomy, the patient is left with a deficit in the upper chest wall. Resulting from this the patient is left with a lack of cleavage or sometimes even a sunken appearance to the upper chest. Utilizing fat grafting, these deficits can be filled out, and the patient left with a more natural contour.

Case: This patient is a 56 year old female who presented with displeasure with her chest wall following a mastectomy and implant placement. After a thorough evaluation and physical examination, I concurred with her complaint. My surgical advice was to utilize micro fat grafting techniques to help fill out the upper chest wall, and achieve natural cleavage for the patient.

 Surgery: I used the abdomen as the donor site for the micro fat grafts. With the use of micro fat grafting cannulas, I reintroduced approximately 55 cc of micro fat grafts to the upper chest wall on the right reconstructed breast and 115 cc on the left reconstructed breast. The breast expanders were replaced with smooth wall, high profile, silicone gel implants with a fill volume of 500 cc bilaterally. At the same time, I revised the left inframammary fold with inferolateral capsulotomy and right-sided capsulorraphy.