Natural Breast Reconstruction — No Implants!
Dr. Joel Aronowitz: “Hi everyone, and welcome to another episode of Aronowitz land. Today, I want to show you a surgery. This is a woman who is under 40 who had breast cancer. She had a nipple-sparing mastectomy, a really good operation, but she had reconstruction with an implant, and the implant caused her a lot of pain and it was uncomfortable. She was also bothered by the fact that it was an artificial implant and she had a lot of immune problems. So, in a future video, I’ll introduce you to her, but for now, I want to show you the operation in which the implant is removed and her own natural fat is harvested from her own body, and then after the fat is prepared with some advanced regenerative techniques, the fat is then injected into the reconstructed breast to add volume. So, it’s a way to reconstruct the breast volume with the patient’s own natural fat. I hope you enjoy the surgery, and I’ll meet you on the other end and explain, recap what we did.
This is a 41-year-old woman who’s about one year status post-nipple sparing mastectomy on the right for breast cancer. She’s had a tissue expander placed, and today I’m going to remove a textured tissue expander. You can see the capsule of the expander. The goal is to replace the expander with natural fat harvested with liposuction from elsewhere on the patient’s body. After separating the textured expander from the capsule, the implant is fairly easily removed. And on the top of the implant, you can see the injection port for the tissue expander. Here’s the capsule of the tissue expander as well as adipose tissue that’s been injected at a previous operation. This will be the second fat grafting procedure to build up fat within the skin envelope in order to replace the tissue expander and avoid the need for a permanent implant. The fat is harvested with liposuction. This is a typical appearance of lipoaspirate. Very little blood, very little oil, and fat particles that are approximately two to three millimeters in diameter, and this can be determined by the cannula that’s used to aspirate the fat. After the lipoaspirate is decanted, it’s injected using a blunt injection cannula with either a 20 or 60 cc syringe, and the fat will be injected as the cannula is withdrawn at various levels within the skin envelope. The capsule of the implant is left intact so that fat does not escape into the tissue expander pocket below. An overcorrection factor of approximately 50% will be injected in order to account for loss of some of the volume due to non-viability of the lipoaspirate graft material. Here, you can see the small holes left by the cannula in the plane between the capsule and the skin envelope. And this is the immediate post-op appearance after the wound has been closed with a typical amount of hyperemia and bruising, and you can notice also that I’ve over-injected so that I have overcorrection of about 50%, roughly. Here’s another view of the pre-op appearance and a view of the post-op appearance after six months with no expander and complete replacement of the volume of the breast with natural fat, and no permanent prosthesis or expander.
I hope you enjoyed that surgery video. It’s really intended for practicing surgeons, but anybody can enjoy it and learn something about it. This is a technique called fat grafting. There’s a lot of different details to an operation like this that make it some more successful than others, and maybe we can get into that in a future video, but for now, I just wanted to demonstrate that it is possible to take out an implant, even in a mastectomy patient where there’s very little native tissue left, except for the skin. We can remove an implant and replace that volume with natural fat, in many cases, and the resulting breast is soft, it’s comfortable, and even though it’s in the breast, it can’t get breast cancer again, obviously, because the fat is coming from elsewhere on the body where someone wouldn’t get breast cancer. So the fat transferred from the abdomen still thinks it’s abdominal fat. The fat from the thigh still thinks it’s thigh fat, so those tissues don’t become cancerous, except in very, very rare cases, so it’s a good way to replace potentially dangerous breast tissue with tissue that has much lower risk of developing cancer or causing other problems, and that is just natural fat tissue. Unfortunately, you can’t really replace breast tissue with fat from someone else’s body. I’ve been asked that before, and no, that’s not possible, but you can use your own fat. Now, most of us have a little extra natural fat on our own body that we can repurpose, so I hope that was interesting. If you have any questions, please leave them in the comments below, and encourage others to subscribe to our channel so we can help grow the channel and spread the word about these reconstructive and cosmetic plastic surgery techniques that are out there. Bye-bye for now.” — Dr. Joel Aronowitz
Originally published at https://drjoelaronowitzmd.blogspot.com/
