FAT GRAFTING ALONE FOR BREAST …...G, Delay E. Percutaneous Fasciotomies and Fat Grafting:...
Transcript of FAT GRAFTING ALONE FOR BREAST …...G, Delay E. Percutaneous Fasciotomies and Fat Grafting:...
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Christophe Ho Quoc, MD Christelle Faure, MD Emmanuel Delay, MD PhD
FAT GRAFTING ALONE FOR BREAST RECONSTRUCTION
Lyon, October 2013 NO DISCLOSURE
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What is a breast?
Shape = skin envelope Volume
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What is a reconstructed breast?
Shape = skin envelope RECONSTRUCTION
Volume RECONSTRUCTION
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What is a reconstructed breast?
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VOLUME RECONSTRUCTION? Implant reconstruction
Ho Quoc C, Delay E. Reconstruction mammaire après mastectomie. J Gynecol Obstet Biol Reprod (Paris) 2013 ;42:29-39
Autologous Latissimus Dorsi reconstructed breasts Delay E, Ho Quoc C. Autologous latissimus dorsi breast reconstruction. In Oncoplastic and Reconstructive Breast Cancer Surgery [in English] – Cicero Urban, Mario Rietjens(Eds), P.267-276, Springer-Verlag Italia 2013 Exclusive lipomodeling breast reconstruction (2001)
Ho Quoc C, Delay E. Breast reconstruction using autologous fat transplantation. In Oncoplastic Surgery of the Breast : how? When? Why? – Eduardo Gonzalez, Alberto Rancati (Eds),
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SKIN RECONSTRUCTION? Implant reconstruction
Autologous Latissimus Dorsi reconstructed breasts Exclusive lipomodeling breast reconstruction (2001)
Abdominal advancement flap Ho Quoc C, Delay E. Reconstruction mammaire après
mastectomie. J Gynecol Obstet Biol Reprod (Paris) 2013 ;42:29-39
Fasciotomies Ho Quoc C, Sinna R, Gourari A, La Marca S, Toussoun
G, Delay E. Percutaneous Fasciotomies and Fat Grafting: Indications for Breast Surgery. Aesthet Surg J;33:995-1001
BRAVA expansion Ho Quoc C, Delay E. Tolérance de la pré-expansion
BRAVA en complément des transferts graisseux d a n s l e s e i n . A n n C h i r P l a s t E s t h é t 2013;58:216-221
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SKIN RECONSTRUCTION? Abdominal advancement flap Ho Quoc C, Delay E. Reconstruction mammaire après
mastectomie. J Gynecol Obstet Biol Reprod (Paris) 2013 ;42:29-39
Fasciotomies Ho Quoc C, Sinna R, Gourari A, La Marca S, Toussoun
G, Delay E. Percutaneous Fasciotomies and Fat Grafting: Indications for Breast Surgery. Aesthet Surg J;33:995-1001
BRAVA expansion Ho Quoc C, Delay E. Tolérance de la pré-expansion
BRAVA en complément des transferts graisseux d a n s l e s e i n . A n n C h i r P l a s t E s t h é t 2013;58:216-221
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SKIN RECONSTRUCTION? Abdominal advancement flap Ho Quoc C, Delay E. Reconstruction mammaire après
mastectomie. J Gynecol Obstet Biol Reprod (Paris) 2013 ;42:29-39
Fasciotomies Ho Quoc C, Sinna R, Gourari A, La Marca S, Toussoun
G, Delay E. Percutaneous Fasciotomies and Fat Grafting: Indications for Breast Surgery. Aesthet Surg J;33:995-1001
BRAVA expansion Ho Quoc C, Delay E. Tolérance de la pré-expansion
BRAVA en complément des transferts graisseux d a n s l e s e i n . A n n C h i r P l a s t E s t h é t 2013;58:216-221
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SKIN RECONSTRUCTION? Abdominal advancement flap Ho Quoc C, Delay E. Reconstruction mammaire après
mastectomie. J Gynecol Obstet Biol Reprod (Paris) 2013 ;42:29-39
Fasciotomies Ho Quoc C, Sinna R, Gourari A, La Marca S, Toussoun
G, Delay E. Percutaneous Fasciotomies and Fat Grafting: Indications for Breast Surgery. Aesthet Surg J;33:995-1001
BRAVA expansion Ho Quoc C, Delay E. Tolérance de la pré-expansion
BRAVA en complément des transferts graisseux d a n s l e s e i n . A n n C h i r P l a s t E s t h é t 2013;58:216-221
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What is BRAVA?
• External Expansion Vacuum Assisted
• Contents: – Dome – Box – Pump – Links
Ho Quoc C, Delay E. Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein. Ann Chir Plast Esthét 2013
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AIM : OEDEMA BREAST
4 weeks after wearing brava
BEFORE SURGRY
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Déroulement d’une séquence de lipomodelage + BRAVA
J0-J10 Débuter BRAVA 10h/jour Box seule J10-J24
BRAVA 10h / j Box + Pompe 2-3 h / j
J24-J28 BRAVA 24h/24h box + pompe 3-4h/j
J+3- J+18 BRAVA 10h / j (si pas de LAA) box seule puis STOP
Nombre de séquences pour la reconstruction d’un sein: • 3-4 en RMD ou RMI • 1-2 en RM partielle
Intervalle libre entre 2 transferts de graisse: 3 MOIS
J0 Début
J0
Début 2ème séquence
BLOC
J+1- J+3 pansement
Ho Quoc C, Delay E. Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein. Ann Chir Plast Esthét 2013
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SURGICAL PROCEDURE
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BRAVA before surgery?
She comes WITH BRAVA for surgical procedure – I take off in surgical room – Surgical procedure
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Ho Quoc C, Delay E. Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein. Ann Chir Plast Esthét 2013;58:216-221
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Ho Quoc C, Delay E. Breast reconstruction using autologous fat transplantation. In Oncoplastic Surgery of the Breast : how? When? Why? – Eduardo Gonzalez, Alberto Rancati (Eds),
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BRAVA and BREAST RECONSTRUCTION :
OUR EXPERIENCE
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BREAST RECONSTRUCTION INDICATIONS
• 31 cases, from 2011 – dec 2012: – 15 total reconstructions :
• 9 Delayed BR (3RT+/6RT-) • 4 Immediate BR (RT-)
– 16 partial reconstructions: • 6 BCS • 5 BR improvements (MSLD) • 4 opposite-side
lipoaugmentations • 1 breast deformitie (thoracic
scar)
0
2
4
6
8
10
12
14
16
% cases
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BREAST RECONSTRUCTION VOLUMES
• 31 cases, from 2011 – dec 2012: – 15 total reconstructions :
• Delayed BR : 1052 cc (818-1568)
• Immediate BR : 700 cc (640-730)
– 16 partial reconstructions: • BCS : 531 cc (300-653)
• MSLD : 317 cc (246-401)
• Lipoaugmentations : 205 cc (180-230)
0
100200300400500600700800900
1000
volume (cc)
total
BCS
MSLD
LipoAugmentation
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BREAST RECONSTRUCTION PROCEDURES
• 31 cases, from 2011 – dec 2012: – 15 total reconstructions :
• Delayed BR : 3-4 • Immediate BR : 2-3
– 16 partial reconstructions • BCS : 1-2 • MSLD : 1-2 • Lipoaugmentation : 1-2
0
0,5
1
1,5
2
2,5
3
3,5
nbre procedures
total
BCS
MSLD
LipoAugmentation
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Case 1 : Immediate BR
51 yo MT (154g) RMI 116cc (1st session) RT-
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2 months po
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1 RMI + 2 sessions BRAVA = 700 cc (116 + 274 + 310) 1 year po
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Case 2 : Immediate BR
1 RMI + 2 sessions BRAVA = 709 cc (129 + 280 + 300) 1 year po
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1 RMI + 2 sessions BRAVA = 709 cc (129 + 280 + 300) 1 year po
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Case 3: Delayed BR
32 yo RT -
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TECHNICAL POINT
• INFRA MAMMARY FOLD+++ – AAF (1st or 2nd
session) – Cannula aspiration
(last procedure)
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4 sessions 1326 cc (300+309+480 +237) And AAF 1 year po
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4 sessions 1326cc (300+309+480+237) And AAF 1 year po
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Case 4 : Delayed BR
54 yo
RT -
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4 sessions 1568cc
(441+354+373+400)
And AAF
1 year po
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Case 5 : Delayed BR
58 yo RT-
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3 sessions 818 cc
(218+260+340)
+ AAF
1 year po
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Case 6 : Severe Case
39 yo RT+ Implant exposure
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4 sessions 909cc (138+231+330 + 210) + AAF 6m po
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BRAVA and OBJECTIVE STUDIES
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RADIOLOGICAL STUDY
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TOLERANCE SYMPTOME PRESENCE CHEZ LES 21
PATIENTES (%)
Douleur
Bruit
Prurit
Erythème
Phlyctènes
Infection
Qualité de sommeil perturbée
Perte de motivation
Arrêt du BRAVA (après cycle amorcé)
Ho Quoc C, Delay E. Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein. Ann Chir Plast Esthét 2013
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TOLERANCE SYMPTOME PRESENCE CHEZ LES 21
PATIENTES (%)
Douleur 0
Bruit 9,5% (2 cas)
Prurit 66% (14 cas)
Erythème 86% (18 cas)
Phlyctènes 5% (1 cas)
Infection 0
Qualité de sommeil perturbée 9,5%
Perte de motivation 0
Arrêt du BRAVA (après cycle amorcé)
0
Ho Quoc C, Delay E. Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein. Ann Chir Plast Esthét 2013
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Discussion
• Efficient Autologous Technique • Small discreet scars • Uncomplicated outcomes • Short hospitalization • Double effect (2 sites treated)
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Discussion
• Limits of the technique : adipose tissue capital, quality of the recipient site
• Indicated breast morphology :
Ø small or moderate volume Ø little projection
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Conclusion • Breast reconstruction with Lipomodeling alone is
possible and can give excellent results in well selected patients
• Very promising technique with additional tools
(fasciotomies, abdominal advancement flap, BRAVA)
• Exclusive Lipomodeling should integrate common breast reconstruction techniques (10-15% patients)
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Team’s experience
Miami, 2011 Lyon, 2011
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www.lyon-lipomodelage-sein.fr
Thank you for your attention