Clinical and ultrasonographic evaluation of breast lipofilling after expander extrusion. Case report.

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.