I recently attended the preeminent breast surgery meeting of the year, sponsored by the Southeastern Society of Plastic and Reconstructive Surgeons (SESPRS). This was the 32nd annual gathering of international thought leaders in plastic surgery. Many new topics have been introduced at this symposium over the years and discussed at length prior to other meetings or journal articles making this a cutting-edge event. I always make time to attend this meeting to ensure that I am offering the most current surgical services for my patients.
Here’s what I gleaned from this year’s symposium:
Fat Grafting – Around a decade ago at this symposium a panel was organized with plastic surgeons, ethicists, lawyers, bio-engineers, oncologists, radiologists and general surgeons to contemplate the concept of moving forward with fat grafting to the breast to override the ban that the American Society of Plastic Surgeons had placed on this technique many years ago. Fortunately, this sparked the movement of our society and our best researchers to invest time and money into the field of plastic surgery. Certainly the clinical experience of utilizing fat grafting to provide shape and improve contours of the breast has been well documented at this meeting before. This year, additional data added further proof that this technique is here to stay.
Dr. Steve Kronowitz, from MD Anderson Cancer Center, presented data that fat grafting does not disrupt the diagnostics of mammography nor does it promote cancer growth in the breast that has been fat grafted. Furthermore, fat grafting maturity in the new recipient tissues stabilizes by four months. Dr. Kronowitz and others have demonstrated that injecting fat cells under badly damaged radiated skin can greatly improve and heal these tissues, although the actual mechanisms have not been fully elicited.
Dr. Louis Bucky, a noted fat-grafting expert from Philadelphia, has demonstrated that large volume fat grafting into areas which have experienced significant neurologic pain from either breast cancer surgery or multiple operations resulting in scaring can provide predictable relief from this pain. The pain relief is the result of delaminating scar tissue and providing fat in its place to avoid further scaring around nerves.
The takeaway from the symposium is that fat grafting in plastic surgery continues to grow in scope and popularity among surgeons and their patients.
New concept for breast reconstruction – Patients who elect to undergo breast reconstruction with implants historically have the devices placed under the pectoralis muscle with or without the use of an Acellular Dermal Matrix (ADM) extending the coverage of the device down to the fold. The muscle provides additional soft tissue coverage of the implant, blending its presence with the surrounding tissues. This approach also has demonstrated benefit in preventing capsular contracture.
The downside of this procedure is animation deformity, meaning that when the muscle is activated during exercise, it will contract and may greatly distort the breast. Also some women will be numb on the skin surface but will have sensation around the muscle and feel the implant movement at times, which can be bothersome. Lastly, during the early postoperative period, placing an implant under the muscle causes a significant amount of muscle spasm pain for a few weeks.
A new interesting concept is removing the muscle from the reconstruction equation by wrapping an ADM graft around the implant then suturing the ADM to the chest wall to stabilize the orientation of either the expander or a final implant without elevating the muscle. This approach mandates having reliable thick mastectomy skin flaps to cover the device with ADM.
A secondary procedure utilizing large-volume fat grafting to provide additional thickness of skin flaps and correct contour deformities is also required three months later. The advantage is quicker surgery time, less pain, no muscle animation issues and no abnormal feelings with the muscle. I plan to offer this to selected patients shortly.
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