Endoscopically assisted aesthetic augmentation of tuberous breasts and fat grafting to correct the double bubble.

Background: Treatment of tuberous breasts types 1 and 2 must deal with the problem of the pseudo-double bubble in the primitive inframammary fold and also must release the constrictive ring. Two techniques currently are used to overcome these problems, but neither is entirely satisfactory. The first technique, in which the approach is via the primitive inframammary fold, leaves significant scarring when the lower poles expand.

Breast reconstruction with fat grafting alone.

We describe our technique for breast reconstruction using fat grafting alone in patients with flaccid, elastic skin, via multiple injections of fat tissue. The technique involves following 3 stages: puckering stitches, to remodel the mass each time fat grafting is performed; cone formation-pexia, the creation and lifting of a cone with the tissue from the area; and neoformation of the inframammary fold, in which the cone is anchored in the pectoralis major and the fold at the level of the sixth rib. Using fat grafting and these 3 maneuvers, we obtain satisfactory breast reconstruction.

Treatment of grade 3 tuberous breasts with Puckett's technique (modified) and fat grafting to correct the constricting ring.

Background: Augmentation of tuberous breasts classified as grade 3 is a challenge to surgeons. The authors describe their technique for correcting grade 3 tuberous breasts with a book-shaped opening of the breast, insertion of an anatomic prosthesis, and fat grafting.

Methods: The authors' technique for correcting grade 3 tuberous breasts consists of reducing the areolar diameter and performing a book-shaped opening of the breast, applying a modified version of Puckett's technique.

Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue.

Background: In secondary mammary reconstruction in irradiated patients, the use of expanders and prostheses is controversial, given that radiotherapy increases tissue fibrosis and capsular contracture. The authors assessed the usefulness of tissue expansion, prostheses, and fat grafting in patients who had received radiotherapy.

Methods: The authors conducted a study of 65 mastectomized patients (age range, 34 to 62 years) who had received radiotherapy with a 6-MeV electron accelerator.