الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Breast reconstruction techniques are nowadays performed as a regular practice and are an essential part of breast cancer management. Most of these techniques have many drawbacks as altered consistency of the reconstructed breast like with implants or additional scar formation in the donor site and change in the texture of the recipient area, as with the autologous flap reconstruction.
This study presents the concept of total breast reconstruction with delayed lipofilling after skin preserving mastectomy (SSM or NSM) followed by immediate reconstruction with an internal tissue expander or implant.
Lipofilling offers a new treatment option; consisting of transferring fatty tissue that has been meticulously harvested and prepared to the deformed breast. We consider lipofilling as a technique with a simple concept but requires a learning curve to avoid the formation of fat necrosis. It yields very good results regarding contour and suppleness of the breast.
The Clinical Human Research included:
Forty-nine sessions were carried out in 25 patients who had undergone delayed lipofilling after skin preserving mastectomy (NSM or SSM) for breast cancer and at least six months after completion of irradiation therapy. They were admitted to the surgical unit of the Medical Research Institute, Alexandria University, in the period from August 2020 to August 2021. All cases were followed up and evaluated for up to one year.
Full laboratory and radiological investigations were performed in all patients. Preoperative markings of both donor and recipient areas were done in a standing position.
The technique used was Coleman‟s technique consisting of:
1. Harvesting by a 2-mm, blunt-edged, two-opening cannula attached to a 50-mL Luer Lock syringe with slight negative pressure after infiltration of Klein’s solution to allow fat harvesting.
2. Processing by centrifuge of aspirated fat under aseptic technique at 3000 rpm for 3 min. The fat is separated into three layers: a top oily layer, a middle layer of purified fat, and a bottom layer of blood residues.
3. Lipoinjection of the cellular component (middle layer) transferred to a 1 or 3 cc Luer-Lock syringe and set for injection by blunt-tipped small-caliber infiltration cannula (1-2 mm).
The findings can be summarized into:
Breast cup size was (A) in 9 cases (36%) and (B) in 16 cases (64%).
64% (16 cases) have taken adjuvant radiotherapy, while 36% (9 cases) have not.
Summary, Conclusions & Recommendations
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The mean total amount of pure fat injected was 508.40 ± 106.60 ml for all sessions. The least amount was 290 ml, and the largest one was 630 ml.
The mean follow-up duration was 9.08 ± 2.3 months; the minimum period was 3 months, and the maximum period was 12 months.
The mean absorption rate subjectively measured after six months was 36.0 ± 12.42 with a minimum of 20% and a maximum of 60%.
Radiological findings were: microcalcifications in 3 cases (12%), oil cysts in 5 cases (20%), and fat necrosis in 7 cases (28%).
Fat necrosis was excised after its appearance in 5 cases (20%).
Factors affecting the occurrence of fat necrosis:
1. Surgical technique
2. Tissue quality
3. Amount of pure fat injected in ml per session
4. History of postoperative radiotherapy
Our aesthetic evaluation was:
Patients satisfaction: By a questionnaire translated into Arabic full filled by all patients; 4 patients (16%) were very satisfied, 11 patients (44%) were satisfied, 2 patients (8%) were unsatisfied 6 patients (24%) were unsatisfied and 2 patients (8%) were very unsatisfied.
Doctor satisfaction was evaluated by two different surgeons; via the clinical examination and the photographic records of each patient before and after the procedure.
The psychological effect of surgery in breast cancer individuals is multi-factorial; the aesthetic result and body appearance are as important as the worry about cancer recurrence. Better cosmetic results produce a better psychological outcome.
Although this technique appears to represent a considerable advance in breast reconstruction, we consider it as only part of a multidisciplinary approach. The radiologist who carries out preoperative investigations must agree with the principle of the procedure, as must the oncologist follow the patient for her cancer. The opinion of all those involved must be respected.