Background: The development of fat grafting techniques both in cosmetic and reconstructive breast surgery has highlighted the need to recreate a breast mound using similar tissues and without visible scarring. Autologous fat grafting has become a common technique for optimizing aesthetic outcomes following breast reconstruction, but there were only a few reports of complete breast reconstruction executed by autologous fat transfer only. This report presents complete breast reconstruction using only large volume autologous fat grafting.
Methods: Our study enrolled 34 female patients, of which 33 patients had undergo modified radical mastectomy, and one patient suffering from Poland’s syndrome between June 2013 and June 2015. Of these case，the time between autologous fat transfer and mastectomy are 2 to 13 years. Patients had no major systemic metabolic diseases or lipid disorders in this study. Before giving treatment，all patients undergo a breast magnetic resonance imaging（MRI） scan or ultrasound examination，and no patients had indications for recurrence of breast cancer. Lipoaspirate was harvested using large-volume fat grafting technique, which included a three holed blunt cannula on a continuous sucion of -400mmHg. The fat was condensed with cotton pad after washing with cold saline and was injected diffusely to the breast. The procedure was repeated every 3 to 12 months until completion. Aesthetic outcomes were assessed according to the breast volume, shape, and symmetry with the opposite breasts after a mean follow-up period of 11 months.
Results: Mean patient age at the time of surgery was 43 years
(range, 21-64 years). A range of 220-350 cc (mean, 252cc) of fat per session was grafted. The mean number of operations per breast required to complete the reconstruction and generate a breast mound was 3.8 (range, two to five). The aesthetic outcomes were graded as excellent for 10 patients, good for 16 patients, fair for 7 patients, and poor for 1 patient. The overall complication rate was 11.7% (4/34). The complications included oil cyst (n = 3), deep infection in injected area (n = 1).

Conclusions: Our results are encouraging regarding the use of autologous fat grafting only for total breast reconstruction. The procedure involves no incision, has minimal complications, and a very high level of patient satisfaction. Our approach was effective, reliable and reproducible with good aesthetic outcomes

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