Two-stage Breast Reconstruction With A Subpectoral Silicone Tissue Expander And Autologous Fat Grafting.

Objective To explore the clinical application of post-expansion prosthesis implantation and autologous fat grafting in post-mastectomy breast reconstructions.Methods In the 1st stage of surgery,bluntly dissect the subpectoral space and insert a 250-300 ml round-shaped tissue expander under local swelling anesthesia.Augment the tissue expander intra-operatively with 80-150 ml of saline with careful concern to the tension of local skin.Regularly inject the saline until the expander is exceeding 30%-50% the volume of the contralateral breast and maintain the volume for over 3 months.During the 2nd stage of surgery,replace the tissue expander with an appropriate prosthesis and fat grafting,autologous fat is grafted under the subcutaneous,inside of the pectoralis and out side of the capsule.according to the size and shape of the contralateral breast,we can graft fat or proceed mastopexy.so that the symmetry of breasts,to a large extent,can be achieved.Results From 2013 to 2016,our department has accomplished 15 cases of implant-based breast reconstruction post tissue expansion with autologous fat grafting,among which 15 cases have completed both stages of surgeries.The follow-up periods range from 1 to 3 years,and the 15 reconstructed breasts have all achieved satisfactory appearances and symmetry with the contralateral breast,in terms of size and position.Conclusions Post-expansion prosthesis implantation and autologous fat grafting in postmastectomy breast reconstructions reduces the risk of prosthesis rupture and improve the volume of soft tissue on the prosthesis;the procedure leads to natural and symmetrical appearance of breasts,concerning volume and position.Moreover,there is no additional donor site and extra scar involved.The post-expansion prosthesis implantation is an ideal option for breast reconstruction.