This was in January 2022 Aesthetic Surgery Journal. “Scarless Composit Breast Reconstruction Utilizing an Advancement Skin Flap, Loops, and Lipofilling.” This was an attempt to use fat transfer to the breast but using advancing a skin flap and a big permanent suture loop to try to improve the shape and give more projection to the breast.
This was a prospective study of 37 women, with an average follow up of around 2 years. The mean age was 54, BMI 29. Flap volume was around 197cc, and the fat transfer were 153 cc for the first session, 190cc for the second session, and 110 cc for the third session. Most patients needed 2 sessions. 94% of patients were satisfied with their post-breast reconstruction shape.
In their technique, they used liposuction to help release the mastectomy tissue. They infiltrated with TXA and tumnescent solution, then broke up the area with the infusion cannulas. They harvested fat from the upper abdomen and lateral chest wall. This was important to further loosen up the tissue, so they could recruit the upper abdomen skin and axilla skin. They actually raised the level of the inframammary fold (where your bra underwire goes.)
The suture loop is a nonabsorbable suture (250c reel of filapeau 2 suture made in France). Two loops are taken around the breast guided by a 3mm 3 hole blunt cannula passed through skin stab incisions. The plane of the stitch is in the superficial tissue in the lower part of the breast (3-9 o’clock) and deeper in the upper quadrants. The loop is pulled with moderate tension to get the same width of the other breast. It is passed twice in the same pattern to minimize tension. The knot is tied. the second loop is to create and fix the new IMF. this is in a more superficial plane. The knot is placed in the same location to make it easy to remove or replace if required. Skin indents and contour deformities are released.
Fat injection is done using vibration, tunnels, and fat injection in all breast quadrants. They end with external vibration to “enhance diffusion of the injected fat” in the breast.
My thoughts?
Their photos were good. The fat grafting ideas are great. I think fat grafting is an awesome tool in our plastic surgery toolbox.
The issue for me is the suture loop. I saw Dr. Khouri do this technique years ago to help shape and do a no scar breast lift. He affixed the loop to muscle or periosteum to try to help with the lift. Sometimes people have chronic pain, or the suture breaks and the lift is lost. In this case, it is a bit different as they are not trying to really lift. They are using the suture to shape which may be better as it isn’t trying to do heavy lifting, just add some shape. The issue with any of the permanent sutures- threadlifts, this surgery, the neck lift- is that a suture can be visible. It can break. It can cause puckering. In general, I have never been a fan.
Also to note, the fat grafting was done usually in 2-3 sessions. This surgery isn’t “one and done,” which is typical when doing fat transfer to the breast for recon.
The follow up here was 2 years. What happens after that? When does the stitch break?
But it should be applauded for its minimally invasive nature and lower scar risk.
Interesting.