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Fat Grafting for Total Autologous Breast Reconstruction: The Role of External Expansion
Gino Rigotti, MD, Alessandra Marchi, MD.
University of Verona, Verona, Italy.

For the past six years we have performed total autologous breast reconstructions with fat grafting safely and effectively. The reconstruction requires a series of small outpatient fat grafting procedures with minimal morbidity, down time and complications. This allows us to sculpt a most naturally looking sensate breast. However, since only a small volume of fat can be successfully grafted at a time, the biggest drawback of this procedure is the number of operations required and the length of time it takes to completely rebuild a breast mound.
Four years ago, in an attempt to remedy this shortcoming, we added external breast expansion into our fat grafting protocol. This study is designed to objectively evaluate the role of external breast expansion in total breast reconstruction with fat grafting.
Before introducing external expansion, we had 15 women totally reconstructed with fat grafting alone. We matched them with the first consecutive 15 women who started with fat grafting and subsequently had external expansion added to their treatment. We also matched them with a third cohort of the first 15 women who were entirely reconstructed with external expansion and fat grafting. The three groups were matched for breast size and complexity of the defects and the procedures were performed using the same surgical technique within a three-year time span. The groups were a as follows:
Group 1 - Used external expansion throughout their reconstruction process.
Group 2 - Started the reconstruction without external expansion and used external expansion later in order to complete it.
Group 3 - Completed the reconstruction without ever using external expansion.
Results: The results are summarized in the table below.
External expansion generated a larger recipient scaffold inside a looser skin envelope. This allowed us to successfully graft a substantially larger amount of fat per session. Our data confirms that external expansion significantly reduced the number of procedures and the length of time required to achieve total mastectomy reconstruction with fat grafting alone. Refinement of our experience with external expansion and fat grafting has since enabled us to reduce the mean number of procedures to 3.7 and to complete the reconstruction within a time period comparable to that of traditional expander/implant procedures.

Grp 1 -Expans. 100%Grp 2 -Expans. LaterGrp 3- No Expans.
Number of Patients151515
Number of Procedures to Complete Breast Reconstruction3 - 63 - 105 - 8
Mean Number of Procedures4.075.87 (p<0.01)6.47 (p<0.001)
Mean Time to Complete Breast Reconstruction9.23 months17.53 m. (p<0.01)19.63 m. (p<0.001)

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