PMC5404643_01
(a) Before mastectomy. (b-d) Images showing the remaining hollowness over the NAC (arrows) and contour irregularities of the breasts after mastectomy and two-staged breast reconstruction.
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However, hollowness over the NAC had remained as well as contour irregularities (Figure 1(a)-(d)) and, therefore, cell-enriched fat grafting near the NAC was considered an option to achieve a more satisfying result.
(a) Image showing the injection sites of ASC-enriched fat grafts. Significant contour improvement after cell-enriched fat grafting at 3 (b) and 22 months (c) of follow-up (d) MRI scan of the right breast showing no shape irregularities after 22 months.
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The resulting cell-enriched fat graft was injected into and around the defect area in multiple planes through blunt-tipped 17-gauge cannulae. As for the right breast, 50 cm3 of cell-enriched fat grafting were injected into the hollowness over the NAC and another 100 cm3 in the upper pole, while 90 and 20 cm3 were used in the upper and the lower pole of the left breast, respectively (Figure 2(a)). There was significant contour improvement in both breasts that remained stable at 3 and 22 months of follow-up (Figure 2(b)-(d)). Two minor complications occurred in the left breast; one episode of cellulitis 4 months post grafting that resolved with IV antibiotics uneventfully, and the development of a slightly painful lump 10 months post grafting that turned out to be a liponecrotic cyst after excision biopsy.
PMC5404643_02
(a) View of the breasts at presentation. (b) Image showing a shape distortion of the left breast 16 months after mastectomy and two-staged breast reconstruction (c), (d) injection sites of ASC-enriched fat grafts.
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Patient was lost to follow-up for 1 year and presented again with marked asymmetry due to shape distortion of the left breast that clinically resembled - though not actually - a capsular contracture (Figure 3(a,b)). Overall, 320 cm3 of enriched fat was grafted in the periphery of the reconstructed breast in order to improve the contour and correct the tethering of the skin (Figure 3(c,d)).
(a, d) Before fat transfer, (b, e) after 3 months and (c, f) after 19 months. MRI scan of the breasts before fat grafting revealing no evidence of capsular contracture (g). A second MRI, 19 months following fat grafting revealing favorable and durable outcomes (h).
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No complications occurred and a satisfying cosmetic result was retained at 3 and 19 months follow-up (Figure 4(a-h)).