Fat grafting in autologous breast reconstruction:applications,outcomes,safety,and complications

Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability;it can be used independently to replace more invasive flap procedures or implants,or as an adjunct for smaller volume supplementation.The breadth of applications in the breast necessitates diversity in technique and approach,and while there is no universally agreed-upon protocol,basic principles have guided the evolution of some commonly adopted tenets.Broadly,fat grafting outcomes are highly favorable but dependent on patient and procedure factors,requiring learned patient selection and expertise in recipient site assessment.Common complications from fat grafting,such as fat necrosis and the development of nodules,are particularly troublesome for post-oncologic patients,requiring considerable pre-surgical consultation for patient education and managing expectations.In addition to volume and contour augmentation,fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or postmastectomy pain syndrome,improved skin quality and reduced fibrosis following radiation,and possible anti-tumorigenic effects.New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma.Preclinically,research towards safe and effective regenerative medicine approaches is actively underway,with the ultimate goal of achieving predictable and increased graft retention,reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.

Chest complications in autologous breast reconstruction

Complications from autologous free flap reconstruction of the breast can present with both common surgical complications and unique complications at the chest recipient site.This review covers complications at the chest recipient site,including chest wall deformity,chronic pain,mastectomy skin flap necrosis,infection,pyoderma gangrenosum,bleeding complications,pneumothorax,chyle leak,and positive internal mammary lymph node metastasis.

Natural History of Seroma Following the Immediate Latissimus Dorsi Flap Method of Breast Reconstruction

Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.

Complications in microsurgical breast reconstruction:thrombosis prevention and management

Breast reconstruction is one of the largest components of plastic and reconstructive surgery.Autologous free flap breast reconstruction continues to grow due to exceptionally high flap success rates.It provides patients with a durable and natural reconstruction with high patient satisfaction.A patent microvascular anastomosis is a key component to a successful autologous free flap breast reconstruction.Thrombus within the vascular anastomosis or the distal flap microcirculation is the most common cause of flap failure.This review aims to discuss microsurgical techniques including atraumatic handling of vessels,appropriate magnification,suture styles,anastomotic techniques,recipient vessel selection,the role of anticoagulation and antiplatelet therapy used to minimize the risk of thrombotic events.When microvascular thrombus occurs,early reoperation and reperfusion is imperative to flap survival.This review will discuss specific maneuvers and intraoperative interventions to maximize flap salvage.