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Tissue Expansion
in Breast Reconstruction
experience in 63 patients with
long-term follow up
Prof. Teodor STAMATE, M.D., Ph.D
.
University of Medicine and Pharmacy “Gr.T. Popa” IASI
Head of Plastic and Reconstructive Surgery Departament
IASI - ROMANIA
Introduction
we present our clinical experience and
results in breast reconstruction using
autologous fat transfer associated with
external tissue expander BRAVA System
in pre- and postoperative care
comparative with classical methods –
internal expander associated with other
techniques for breast reconstruction.
1- VOLUME RESTAURATION OF THE
ABSENT OR AMPUTATED BREAST
2- SYMMETRISATION
WITH THE OPPOSITE BREAST
3- NAC RECONSTRUCTION
• NAC
• lateral to the midclavial line in 2 cases
• Inferior to the normal position in 1 case
48 cases
Poland
Syndrome
Prof. Teodor STAMATE, M.D., Ph.D.
45
40
35 POLAND
30
Major
25 Hypotrophy
20 Minor
Hypotrophy
15
AMASTIA
10
5
0
insufficient
quantity after
mastectomy or
Poland Syndrome
ITE is mandatory to
be placed into a
musculo-
cutaneous
pocket
Internal Tissue Expander
ITE are two types :
First step :
a) Placing a tissue
expander to create extra
– skin and to expand
the hypotrophic
pectoralis major
d) Two weeks
postoperatively
expander inflation
begins (20-40 ml
/ week).
e) Elastic strapping
to maintain
constant pressure
over the myo-
cutaneous
structures
situated under the
horizontal plane
that passes
through the
opposite nipple .
Second step
a) 3 months
postoperatively
the expander is
withdrawn and
the final 250 ml
implant is
inserted.
b) Wound closure in
separate planes
3 days postoperatively
2 months postoperatively
FINAL OUTCOME
Prof. Teodor STAMATE, M.D., Ph.D.
Right
mammary
agenesia
Absence of
pectoralis
major
Hypoplasia
of pectoralis
minor
Prominence
of the 3rd
costo-sternal
cartilage
NAC < 2,5
cm +
malposition
Tailoring the
latissimus
dorsi flap
A hammock is
created to support
the final implant
Insertion of the
final implant
supported by the
muscular flap
Techniques Points
The preliminary expansion of the flap avoid the prelevation of o
big size cutaneous palette and the direct closing for the donor
site
This procedure have the inconvenient to the supplementary
surgery time but the important advantage is the tessellate
infusion
Breast reconstruction by
Musculo-cutaneous pedicled L.D. Flap
Delaporte T., Sinna R.,. Perol D, Garson S., Vasseur C. and E. Delay . Bilateral breast
reconstruction with the autologous latissimus dorsi flap (a retrospective study of 31
consecutive cases) . Annales de Chirurgie Plastique Esthétique. Vol. 51, nr. 6,
December 2006, Pages 482-493
Breast reconstruction by
musculo-cutaneous pedicled L.D. Flap
associate with Internal Tissue Expander
First step
Tissue
Expander
Breast reconstruction by
muscular pedicled L.D. Flap
associate with Internal Tissue Expander
Expander 2
Breast reconstruction by
muscular pedicled L.D. Flap
associate with Internal Tissue Expander
2 Temporary ITE
Breast reconstruction by
muscular pedicled L.D. Flap
associate with Internal Tissue Expander
After three
months
Breast reconstruction by
muscular pedicled L.D. Flap
associate with Internal Tissue Expander
Muscular LD Flap after expansion
BRAVA System
Miami 14.02.2010
Roger Khouri
BRAVA System
Breast Reconstruction after Mastectomy
Initial aspect
FAT TRANSFER +
BRAVA System
FAT TRANSFER +
BRAVA System
“orange skin”
Initial aspect
* Valdatta L, Thione A, Buoro M, et al. A case of life-threatening sepsis after breast augmentation by fat
injection. Aesthetic Plast Surg 2001;25:347-9
Complications
6,5 X 5,5 mm
skin puncture
aspiration
*C.W. Chan , S.J. McCulley , R.D. Macmillan. Autologous fat transfer e a review of the literature
with a focus on breast cancer surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery (2008) 61, 143-1448
Hyperchrome scars
Tubular breast asymmetry – BRAVA Syst + Fat transfer
19 cases with
Fat Transfer in
Breast
Reconstruction
3 cases with
liponecrosis
cysts (15,7%)
1 case with
hyperchrome
scars
FAT 1
13 60-180 cc
TRANSFER
STAGES
2
4 80-150 cc
3
2 80-100 cc
Roger Khouri