Large-breast reconstruction using fat graft only after prosthetic reconstruction failure.

BACKGROUND: When prosthetic reconstruction fails, and in the case of absolute contraindications to flaps use, no common reconstructive option is available. METHODS: A large irradiated breast was reconstructed using only fat grafts (9 sessions) after prosthetic reconstruction failure (exposure of implant) due to absolute contraindications to general anesthesia and unavailability of large flaps. During the first four sessions small volumes were implanted in the extremely rigid and retracted tissues with regenerative purposes. Larger volumes were implanted during the last five sessions to improve volume and shape. RESULTS: A pleasant aesthetic result was achieved. Tissue regeneration with good vascular support was evident at ultrasonography and magnetic resonance. Histologic and ultrastructural examination of the new tissue showed normal adipose tissue with cell and vasculostromal maturation aspects. No degenerative or inflammatory aspects were present. CONCLUSION: Fat graft transplantation can be a reliable and safe option for breast reconstruction in selected patients.