Editing Breast augmentation (section)

===Post-mastectomy procedures===
Surgical post-mastectomy [[breast reconstruction]] requires general anaesthesia, cuts the chest muscles, produces new scars, and requires a long post-surgical recovery for the patient. The surgical emplacement of breast implant devices (saline or silicone) introduces a foreign object to the patient's body (see [[capsular contracture]]). The [[TRAM flap]] (Transverse Rectus Abdominis Myocutaneous flap) procedure reconstructs the breast using an autologous flap of abdominal, cutaneous, and muscle tissues. The latissimus myocutaneous flap employs skin fat and muscle harvested from the back, and a breast implant. The [[DIEP flap]] (Deep Inferior Epigastric Perforators) procedure uses an autologous flap of abdominal skin and fat tissue.<ref name="Khouri RK 2010">Khouri RK (2010) Non-surgical breast reconstruction with autologous fat-grafts</ref>{{incomplete reference|date=January 2024}}

====Post-mastectomy fat-graft reconstruction====
The reconstruction of the breast(s) with grafts of autologous fat is a non-implant alternative to further surgery after a breast cancer surgery, be it a [[lumpectomy]] or a breast removal{{snd}}simple (total) mastectomy, radical mastectomy, modified radical mastectomy, skin-sparing mastectomy, and [[Nipple delay|subcutaneous (nipple sparing) mastectomy]]. The breast is reconstructed by first applying external tissue expansion to the recipient-site tissues ([[adipose]], [[gland]]ular) to create a breast-tissue matrix that can be injected with autologous fat grafts (adipocyte tissue); the reconstructed breast has a natural form, look, and feel, and is generally sensate throughout and in the nipple-areola complex (NAC).<ref name="Khouri RK 2010" /> The reconstruction of breasts with fat grafts requires a three-month treatment period{{snd}}begun after 3–5 weeks of external vacuum expansion of the recipient-site tissues. The autologous breast-filler fat is harvested by liposuction from the patient's body (buttocks, thighs, abdomen), is refined and then is injected (grafted) to the breast-tissue matrices (recipient sites), where the fat will thrive.

One method of non-implant breast reconstruction is initiated at the concluding steps of the breast cancer surgery, wherein the [[Oncology|oncological]] surgeon is joined by the reconstructive plastic surgeon, who immediately begins harvesting, refining, and seeding (injecting) fat grafts to the post-mastectomy recipient site. After that initial post-mastectomy fat-graft seeding in the operating room, the patient leaves hospital with a slight breast mound that has been seeded to become the foundation tissue matrix for the breast reconstruction. Then, after 3–5 weeks of continual external vacuum expansion of the breast mound (seeded recipient-site){{snd}}to promote the [[Histology|histologic]] regeneration of the extant tissues ([[adipose|fat]], [[gland]]ular) via increased blood circulation to the mastectomy scar (suture site){{snd}}the patient formally undergoes the first fat-grafting session for the reconstruction of her breasts. The external vacuum expansion of the breast mound created an adequate, [[Circulatory system|vascularised]], breast-tissue matrix to which the autologous fat is injected; and, per the patient, such reconstruction affords almost-normal sensation throughout the breast and the nipple-areola complex. Patient recovery from non-surgical fat graft breast reconstruction permits her to resume normal life activities at 3-days post-procedure.<ref name="Khouri RK 2010" />


====Tissue engineering====
=====The breast mound=====

The breast-tissue matrix consists of engineered tissues of complex, implanted, biocompatible scaffolds seeded with the appropriate cells. The ''in-situ'' creation of a tissue matrix in the breast mound is begun with the external vacuum expansion of the mastectomy defect tissues (recipient site), for subsequent seeding (injecting) with autologous fat grafts of adipocyte tissue. A 2010 study, reported that serial fat-grafting to a pre-expanded recipient site achieved (with a few 2-mm incisions and minimally invasive blunt-cannula injection procedures), a non-implant outcome equivalent to a surgical breast reconstruction by [[DIEP flap|autologous-flap]] procedure. Technically, the external vacuum expansion of the recipient-site tissues created a skin envelope as it stretched the mastectomy scar, and so generated a fertile breast-tissue matrix to which were injected large-volume fat grafts (150–600&nbsp;ml) to create a breast of natural form, look, and feel.<ref name="ReferenceC">Khouri RK, Cardoso E, Marchi A, Rigotti G. (2010) [https://www.miamibreastcenter.com/reconstruction/tissue-engineering-breast-autologous-fat-grafting Tissue Engineering a Breast Mound by External expansion & Autologous fat Grafting] {{Webarchive|url=https://web.archive.org/web/20150408081617/http://www.miamibreastcenter.com/reconstruction/tissue-engineering-breast-autologous-fat-grafting |date=2015-04-08 }}. miamibreastcenter.com</ref>

The fat graft breast reconstructions for 33 women (47 breasts, 14 irradiated), whose clinical statuses ranged from zero days to 30 years post-mastectomy, began with the pre-expansion of the breast mound (recipient site) with an external vacuum tissue-expander for 10 hours daily, for 10–30 days before the first grafting of autologous fat. The breast mound expansion was adequate when the mastectomy scar tissues stretched to create a 200–300&nbsp;ml recipient matrix (skin envelope), that received a fat-suspension volume of 150–600&nbsp;ml in each grafting session.<ref name="ReferenceC"/>

At one week post-procedure, the patients resumed using the external vacuum tissue-expander for 10 hours daily, until the next fat grafting session; 2–5 outpatient procedures, 6–16 weeks apart, were required until the plastic surgeon and the patient were satisfied with the volume, form, and feel of the reconstructed breasts. The follow-up mammogram and [[MRI]] examinations found neither defects (necrosis) nor abnormalities ([[Breast diseases|neoplasms]]). At six months post-procedure, the reconstructed breasts had a natural form, look, and feel, and the stable breast-volumes ranged 300–600&nbsp;ml per breast. The post-procedure mammographies indicated normal, fatty breasts with well-vascularized fat, and few, scattered, benign oil cysts. The occurred complications included [[pneumothorax]] and transient cysts.<ref name="ReferenceC"/>

=====Explantation deformity=====
The autologous fat graft replacement of breast implants (saline and silicone) resolves [[Complications (medical)|medical complications]] such as: [[capsular contracture]], implant shell rupture, filler leakage (silent rupture), device deflation, and silicone-induced [[granulomas]], which are medical conditions usually requiring re-operation and explantation (breast implant removal). The patient then has the option of surgical or non-implant breast corrections, either replacement of the explanted breast implants or fat-graft breast augmentation. Moreover, because fat-grafts are biologically sensitive, they cannot survive in the empty implantation pocket, instead, they are injected to and diffused within the breast-tissue matrix (recipient site), replacing approximately 50% of the volume of the removed implant{{snd}}as permanent breast augmentation. The outcome of the explantation correction is a bust of natural appearance; breasts of volume, form, and feel, that{{snd}}although approximately 50% smaller than the explanted breast size{{snd}}are larger than the original breast size, pre-procedure.

=====Breast augmentation=====

The outcome of a breast augmentation with fat-graft injections depends upon proper patient selection, preparation, and correct technique for recipient site expansion, and the harvesting, refining, and injecting of the autologous breast filler fat. Technical success follows the adequate external vacuum expansion of the recipient-site tissues (matrix) before the injection of large-volume grafts (220–650&nbsp;cc) of autologous fat to the breasts.<ref>{{cite web|url=http://www.thaimedicalvacation.com/cal-stem-cell-breast/ |title=Autologous cell enriched breast lipotransfer | access-date=2012-07-07}}</ref> After harvesting by liposuction, the breast-filler fat was obtained by low G-force syringe centrifugation of the harvested fat to separate it, by density, from the crystalloid component. The refined breast filler then was injected to the pre-expanded recipient site; post-procedure, the patient resumed continual vacuum expansion therapy upon the injected breast, until the next fat grafting session. The mean operating room (OR) time was 2-hours, and there occurred no incidences of [[infection]], cysts, [[seroma]], [[hematoma]], or tissue necrosis.<ref name="Del Vecchio D pp. 68">{{Cite journal | last1 = Del Vecchio | first1 = D. A. | last2 = Bucky | first2 = L. P. | s2cid = 205969440 | doi = 10.1097/PRS.0b013e3182050a64 | title = Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: A Clinical Radiographic Study | journal = Plastic and Reconstructive Surgery | volume = 127 | issue = 6 | pages = 2441–2450 | year = 2011 | pmid = 21311393 }}</ref>

The breast-volume data reported in ''Breast Augmentation with Autologous Fat Grafting: A Clinical Radiological Study'' (2010) indicated a mean increase of 1.2 times the initial breast volume, at six months post-procedure. In a two-year period, 25 patients underwent breast augmentation by fat graft injection; at three weeks pre-procedure, before the fat grafting to the breast-tissue matrix (recipient site), the patients were photographed, and examined via intravenous contrast [[MRI]] or [[X-ray computed tomography|3-D volumetric imaging]], or both. The breast-filler fat was harvested by liposuction (abdomen, buttocks, thighs), and yielded fat-graft volumes of 220–650&nbsp;cm<sup>3</sup> per breast. At six months post-procedure, the follow-up treatment included photographs, intravenous contrast MRI or 3-D volumetric imaging, or both. Each woman had an increased breast volume of 250&nbsp;cm<sup>3</sup> per breast, a mean volume increase confirmed by quantitative MRI analysis. The mean increase in breast volume was 1.2 times the initial breast volume measurements; the statistical difference between the pre-procedure and the six-month post-procedure breast volumes was (P< 00.0000007); the percentage increase basis of the breast volume was 60–80% of the initial, pre-procedure breast volume.<ref name="Del Vecchio D pp. 68"/>