Multiple polyurethane implant punctures during fat grafting: case report and review of the literature
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CASE REPORT
Multiple polyurethane implant punctures during fat grafting: case report and review of the literature Dmitry Batiukov1* , V. Podgaiski2, D. Mikulich3 and S. Kalinin4
Abstract Background: Breast augmentation with implants continues to be the most popular aesthetic surgical procedure performed worldwide. Fat grafting may improve the results of breast augmentation and breast reconstruction with implants. However, fat grafting to the breast with implants carries the risk of implant puncture. To our best knowledge this is the first case in which polyurethane implant puncture during fat grafting is described. Case presentation: We report multiple bilateral implant punctures with the cannula during fat grafting in a patient who previously underwent breast reconstruction with polyurethane implants. Conclusions: Implants that promote tissue ingrowth may be more prone to puncture with the cannula during fat grafting. Specific planning and surgical maneuvers decrease the risk of implant puncture. Level of evidence: Level V, case report. Keywords: Polyurethane implants, Fat grafting, Implant puncture, Breast reconstruction, Breast augmentation, Implant puncture Background Breast augmentation (BA) with implants continues to be the most popular aesthetic surgical procedure performed worldwide [1, 2]. Fat grafting (FG) may improve the results of BA and breast reconstruction with implants by thickening and refining the skin envelope, filling residual defects (rippling, double bubble etc.), adding volume, changing the form and avoiding submuscular implant placement [3–13]. Simultaneous combination of BA with implants and FG is called hybrid or composite BA [6, 11, 12, 14, 15]. FG to the breast with implants inside carries the risk of the implant puncture. This is particularly possible if FG is performed as a secondary procedure without visualizing the implant pocket, when tissues are thin, fibrous and force is needed to pass the cannula. The *Correspondence: [email protected] 1 Medical Center “Antes Med”, Kozlova Lane 25‑7, 220037 Minsk, Belarus Full list of author information is available at the end of the article
incidence of implant puncture during fat grafting is not reported in the literature.
Case presentation Patient B, 36 years old made an appointment at another institution complaining of multiple painful lumps in both breasts. She already had a sectoral resection of the right breast because of multiple fibroadenomas two years ago. The anamnesis was unremarkable. She was diagnosed with bilateral fibrocystic breast disease, multiple fibroadenomas of the right breast, BRCA negative. Bilateral subcutaneous mastectomy with DTI subpectoral reconstruction with polyurethane implants and periareolar mastopexy was performed. The postoperative period was unremarkable. Three months after the surgery on the follow up the patient complained of the breast asymmetry and soft tissue deformity and 4 months after primary surgery secondary periareolar mastopexy was performed. The postoperative course
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