Moderate sequelae of conservative treatment of breast cancer are a real challenge for the surgeon.1 No technique yet gave entirely satisfactory results. The only options offered to patients, such as musculocutaneous latissimus dorsi flaps,2,3 were often disabling and disproportionate to the breast deformity.1 But a few years after treatment of their cancer, patients are very eager for surgical correction of their deformity to erase or attenuate the visible signs of their disease. It was therefore important to seek a solution that would correct these sequelae and help these patients to regain better self-esteem and to reintegrate their breast in their body image.
We had obtained very good results with fat transfer in the face, and so in 1998 we proposed fat transfer for breast improvement after reconstruction. We first introduced this approach after autologous latissimus dorsi flap reconstruction.4,5 Finding that fat transfer was effective and innocuous, we proposed using it to correct therapeutic sequelae of the breast. We carried out a radiological study on reconstructed breasts that had undergone lipomodeling, and this showed no deleterious effects on breast imaging.6
This chapter presents the information that should be given to the patients and the precautions that should be taken before carrying out this procedure, the surgical technique, the results that may be expected, the advantages and drawbacks of the technique, the potential radiological appearance after lipomodeling, and lastly the possible medicolegal aspects if local recurrence of cancer occurs coincidentally with lipomodeling.
The use of fat transfer in breast surgery is not a new concept.7 More recently, and from the early days of modern liposuction, Illouz8 and Fournier9 suggested using the fat obtained from liposuction for moderate breast augmentations. Bircoll10 presented a similar approach and drew attention to the advantages of this technique in a paper published in February 1987 in the Journal of Plastic and Reconstructive Surgery10: simplicity, absence of residual scarring, early return to normal activity, elimination of the need for implants and also their complications, with an additional secondary advantage in the areas of fat harvesting. Then in April 1987 he published11 a report of a patient who had undergone bilateral fat transfer after unilateral reconstruction with a transverse rectus abdominis muscle flap (improvement of the reconstructed breast and restoration of symmetry). These 2 papers at once prompted considerable extremely virulent opposition.12-16 His detractors underlined the fact that fat injections in a native breast could produce microcalcifications and cysts, making a cancer difficult to detect. Although Bircoll stressed in his replies17,18 that the calcifications after fat transfer differ from neoplastic calcifications by their location and their radiological appearance, and that breast reduction surgery also generates microcalcifications, the debate started unfavorably, and in 1987, the American Society of Plastic and Reconstructive Surgeons (ASPRS) ruled as follows: "The committee is unanimous in deploring the use of autologous fat injection ...