Aesthetic Improvement Of Fat-graft Reconstruction Using A Novel "Star Flap" And Inframammary Fold Recreation By Liposuction

Objective:To observe aesthetic outcomes of nipple reconstruction using a novel designed “star flap” in b reast reconstruction with free fat graft after total mastectomy.Contribution of a inframammary fold recreation by liposuction to breast shape improvement was evaluated.Methods:From August 2017 to December 2018,19 patients,aged 28-55 years,who suffered breast can cer and received unilateral total mastectomy were included in this study.After breast reconstruction with autologous fat transplantation for at least one year,a local star shaped flap was raised.Roll ed free dermal-fat matrix harvested subcutaneously from reconstructed breast was implanted within the core of flap,which resulted in an additional 4-6mm projection beyond elevated flap.Meanwhil e,an inframammary fold was reconstructed by local liposuction.At 7 days,3 months and 6 mont hs after operation,nipple position,diameter,projection as well as symmetry with contralateral nipp le was evaluated.In addition,the shape of inframammary fold was observed.Six months after nip ple reconstruction,subjective and objective satisfaction investigation was conducted to evaluate the efficacy of the outcomes.Results:All patients who underwent nipple and inframammary fold reconstruction recovered well after surgery.Among them,1 case hadof poor wound healing and,1 case of local congestion of the s kin flaps was observed,respectively,after operation No nipple necrosis was found.Position of the reconstructed nipple were symmetrical with the contralateral side Shrinkage of the nipple projectio n was continuously observed,which resulted a more nature projection after 6 months.The degree of satisfaction(very satisfactory,satisfied,basically satisfied,unsatisfactory,very unsatisfactory)in the study group was 26.3%,52.6%,22.9%,5.3% and 0%,respectively,while that in the control gr oup was 0%,18.1%,45.5%,36.4%,8.3%,(Z = 3.451,P = 0.01).There was statistical difference in the distribution of satisfaction effect between the two groups.Conclusions:1.The star flap buried with dermal-fat plug showed good postoperatively.In combined with i nframammary fold recreation with liposuction,the aesthetic outcome was greatly improved for reco nstructed breast with free fat graft.2.A high satisfaction was achieved using the combined reconstruction of nipple and inframa mmary fold.3.The approach of a combined reconstruction of nipple and inframammary fold is safe and reliable,showing no significant complications in the duration of 6 months post-surgery.