Clinical and Ultrasonographic Evaluation of Breast Lipofilling After Expander Extrusion. Case Report

Overview

Journal Med Pharm Rep

Specialty General Medicine

Date 2025 Feb 14

PMID 39949915

Authors

Razvan-George Bogdan

Alina Helgiu

Anca-Maria Cimpean

Zorin Petrisor Crainiceanu

Affiliations

Soon will be listed here.

Abstract

Background: Breast cancer treatment often involves mastectomy and adjuvant therapies such as radiotherapy, which can lead to complications in reconstructive procedures. Tissue expanders are commonly used for immediate breast reconstruction post-mastectomy, but radiation therapy increases the risk of complications like expander extrusion. Lipofilling has emerged as a promising technique to address tissue damage and improve reconstructive outcomes. This case illustrates the utility of ultrasonography in measuring fat thickness before and after the lipofilling procedure and calculating the resorption rate for managing complex post-radiation complications.

Case Description: We report the case of a 38-year-old patient born and raised in Romania with a history of right breast cancer, who initially underwent mastectomy followed by immediate reconstruction with a subpectoral tissue expander. The patient subsequently received adjuvant radiotherapy, which led to the extrusion of the tissue expander and chronic pain with skin redness. Due to significant damage to the surrounding tissue and chest wall, lipofilling was employed as a reconstructive approach to enhance skin quality and support tissue regeneration. Fat grafting was performed in multiple sessions, with ultrasonographic evaluations conducted before and after each session to monitor volumetric changes in the reconstructed breast. Following lipofilling, the patient experienced marked improvements in skin texture and breast volume, with no recurrence of complications. Later that year we performed a DIEP flap.

Conclusions: This case demonstrates the efficacy of ultrasonography in measuring fat graft and fat resorption after lipofilling as a reconstructive strategy in patients who experience complications from tissue expander extrusion post-radiation. Lipofilling, in combination with thorough imaging assessments, can significantly enhance the outcomes of breast reconstruction following radiotherapy.

References

Herly M, Muller F, Orholt M, Hansen J, Svaerke S, Hemmingsen M . The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: A validation study. J Plast Reconstr Aesthet Surg. 2019; 72(8):1278-1284. DOI: 10.1016/j.bjps.2019.03.029. View

Heine N, Eigenberger A, Brebant V, Hoesl V, Brix E, Prantl L . Comparison of skin sensitivity following breast reconstruction with three different techniques: Autologous fat grafting, DIEP flap and expander/implant1. Clin Hemorheol Microcirc. 2021; 80(4):389-397. DOI: 10.3233/CH-219203. View

Kolle S, Oliveri R, Glovinski P, Elberg J, Fischer-Nielsen A, Drzewiecki K . Importance of mesenchymal stem cells in autologous fat grafting: a systematic review of existing studies. J Plast Surg Hand Surg. 2012; 46(2):59-68. DOI: 10.3109/2000656X.2012.668326. View

Mojallal A, Foyatier J . [Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery]. Ann Chir Plast Esthet. 2004; 49(5):419-25. DOI: 10.1016/j.anplas.2004.08.004. View

Herold C, Ueberreiter K, Busche M, Vogt P . Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg. 2013; 37(2):380-7. DOI: 10.1007/s00266-012-0046-4. View

Ahmad N, Anker A, Klein S, Dean J, Knoedler L, Remy K . Autologous Fat Grafting-A Panacea for Scar Tissue Therapy?. Cells. 2024; 13(16). PMC: 11352477. DOI: 10.3390/cells13161384. View

Smith-Ryan A, Fultz S, Melvin M, Wingfield H, Woessner M . Reproducibility and validity of A-mode ultrasound for body composition measurement and classification in overweight and obese men and women. PLoS One. 2014; 9(3):e91750. PMC: 3950249. DOI: 10.1371/journal.pone.0091750. View

Debald M, Pech T, Kaiser C, Keyver-Paik M, Walgenbach-Bruenagel G, Kalff J . Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal. Eur J Plast Surg. 2017; 40(5):447-454. PMC: 5610213. DOI: 10.1007/s00238-017-1311-1. View

Storchle P, Muller W, Sengeis M, Ahammer H, Furhapter-Rieger A, Bachl N . Standardized Ultrasound Measurement of Subcutaneous Fat Patterning: High Reliability and Accuracy in Groups Ranging from Lean to Obese. Ultrasound Med Biol. 2016; 43(2):427-438. DOI: 10.1016/j.ultrasmedbio.2016.09.014. View

10.

Carpene C, Les F, Hasnaoui M, Biron S, Marceau P, Richard D . Anatomical distribution of primary amine oxidase activity in four adipose depots and plasma of severely obese women with or without a dysmetabolic profile. J Physiol Biochem. 2016; 73(3):475-486. DOI: 10.1007/s13105-016-0526-0. View

11.

Heine N, Eigenberger A, Brebant V, Kempa S, Seitz S, Prantl L . The effect of radiotherapy on fat engraftment for complete breast reconstruction using lipofilling only. Arch Gynecol Obstet. 2022; 307(2):549-555. PMC: 9918565. DOI: 10.1007/s00404-022-06610-4. View

12.

Szymankiewicz M, Nowikiewicz T, Biedka M . Significance of Infections in Implant Loss After Breast Reconstruction in the Course of Breast Cancer Treatment. Pol J Microbiol. 2019; 68(3):343-351. PMC: 7256728. DOI: 10.33073/pjm-2019-037. View

13.

Uhlmann N, Martins M, Piato S . 3D areola dermopigmentation (nipple-areola complex). Breast J. 2019; 25(6):1214-1221. DOI: 10.1111/tbj.13427. View

14.

Visser N, Damen T, Timman R, Hofer S, Mureau M . Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg. 2010; 126(1):26-36. DOI: 10.1097/PRS.0b013e3181da87a6. View

15.

Khouri R, Rigotti G, Khouri Jr R, Cardoso E, Marchi A, Rotemberg S . Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience. Plast Reconstr Surg. 2015; 135(3):643-658. DOI: 10.1097/PRS.0000000000001039. View