Objectives: 1. Finding the most reliable tool in objective breast volume assessment.
2. Comparing MRI breast volumetry (as being the most acceptable tool for breast volume assessment) to 3D camera breast volumetry.
3. Improving the outcome in the correction of breast asymmetry after objective assessment of breast volume bilaterally and getting the volume difference needed to be corrected.

Introduction: The female breast is a universal symbol of sexuality, motherhood and femininity.
Breast symmetry is a vital aspect of the female form.
Obvious breast asymmetry becomes an aesthetic and psychological problem.
The goal of breast surgery is to provide symmetric breasts with an acceptable shape, volume, glandular configuration.
When managing breast asymmetry, a more precise method for breast volume assessment is needed.
Several methods have claimed to be accurate; they have failed to gain acceptance as routine due to their high costs, technical difficulties, and patient discomfort.

Materials / method: This study was done within the period of November 2015 to September 2019, on 20 female patients seeking breast asymmetry correction at Kasr El-Ainy hospital, with Mean age: 30.4.
All patients have done volumetric breast assessment using the 3D imaging system (3D LifeViz®, Quantificare system).
Breast MRI volumetry was done to confirm the results of the 3D system.
Different surgical techniques were used to manage those patients in a single stage procedure after an objective volume assessment to the volume difference between the two breasts.

Results: Breast volume assessment using the 3D camera was done in both breasts in Pre and Post-operative period where the preoperative mean difference was 159.45cc and the postoperative mean difference was 16.75cc with overall reduction percentage in mean size difference was 89.5%.
Breast MRI volumetry was done to confirm the results with the 3D camera, the right breast average difference was 7.1cc and in the left breast average difference was 6.3cc. The gap difference between both methods showed an average of 2.4cc and this showed no statistical difference between them. P <.05 (P =.004338).

Conclusion: Using this technology appears to offer a promising future because of its multiple applications particularly in clinical practice.
The technology challenges the subjectivity of surgery, allowing the more likely obtainment of predictable and defined results, improving patient satisfaction and serving as an objective and reliable measurement tool for the breast including the volume, shape, surface area measurements to improve the quality of interventions and outcomes.

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Objectives: To establish the role of fat grafting in Alloplastic Breast Reconstruction in the setting of Radiation therapy.

Introduction: Implant based breast reconstruction is commonly avoided in the setting of radiation therapy, mainly due to risks of capsular contracture (CC). We believe that fat grafting adds effectiveness to the management of CC and thus we review treatment methods and outcomes of such patients in order to establish the role of fat grafting and to assess whether alloplastic techniques are an adequate option.

Materials / method: We reviewed charts of patients who developed CC following alloplastic breast reconstruction followed by radiation therapy, between 2007-2017. The surgical treatment methods for CC were evaluated along with their outcomes. A follow up of at least 6 months was required.

Results: Forty-eight breasts with post-radiation CC, underwent surgical implant exchange with capsulotomy, of which 15 had combined fat grafting and 33 did not. Overall, 35 (72.9%) breasts showed long-term resolution of CC, of which 24 underwent a single procedure and 11 required an additional fat grafting procedure. Seven (14.5%) breasts were offered a consecutive round of fat grafting, and 6 (12.5%) had autologous reconstruction due to lack of improvement. Fat grafting increased the success rate by more than 30% when it was initially and consecutively employed to treat CC.

Conclusion: Despite traditional avoidance of alloplastic breast reconstruction in the setting of radiation therapy, novel techniques using fat grafting show a reasonable success rate of 73% CC-free results. Once CC is established, fat grafting combined with capsulotomy and implant exchange, may improve outcomes and reduce the need for salvage procedures.

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Objectives: Autologous fat transplantation has gained great recognition in aesthetic and reconstructive surgery.
The use of Micro fat Graft in large volumes in breast augmentation is of great value.

Introduction: Autologous fat transplantation has gained great recognition in aesthetic and reconstructive surgery. Two main aspects are of predominant importance for progress control after autologous fat transplantation to the breast: quantitative information about the rate of fat survival in terms of effective volume persistence and qualitative information about the breast tissue to exclude potential complications of autologous fat transplantation.

Materials / method: 137 patients underwent unilateral and bilateral mega volume micro fat grafting of the breast to treat asymmetry and hypoplasia and ptosis with various amounts of volume transferred to the breast in a 3d manner.

Results: Radiological analysis was performed in some patients after the last lipofilling procedure, demonstrating a mean of 371 mL (range 64-538 mL) of transferred fat per side, a mean fat survival of 73% our to several factors.

Conclusion: mega volume micro fat grafting is a low-risk procedure that can be used to correct breast asymmetry and breast hypoplasia.

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Objectives: Evaluate safety and results of breast fat grafting with 2020 acknowledgment in order to understand the future of this procedure

Introduction: Autologous fat grafting represents a quite common technique for breast augmentations as well as for reconstructive breast surgery. The procedure is an easy-to-perform and reliable technique, with satisfactory results. Over the last two years the renewed interest in lipofilling has been primarily concerned with its use in classical breast augmentation to cover the implant in order to avoid the direct stimulation of silicon texturized surface.

Materials / method: In the last 20 years we performed 482 breast lipofilling using different parameters’ tecniques. The variables have been diameter of canulas, harvesting and injecting, way of fat preparing, injections level, space creating, amount of fat transplanted.

Results: The complication rates is low (<9% of procedures), and most were minor; no evidence of increased breast cancer incidence after lipofilling.

Conclusion: Despite breast fat transplant looks an easy technique and complications rate low, selection of patient is essential and a very careful application of the most recent recommendations is mandatory.

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Objectives: Currently, the authors present their experience using regenerative cell therapy in breast reconstruction. The goal of this study was to evaluate the safety and ecacy of the use of Engineered Fat Graft Enhanced with Adipose-derived Stromal Vascular Fraction cells (EF-e-A) in breast reconstruction.

Introduction: The areas in which Stromal Vascular Fraction cells (SVFs) have been used include radiotherapy based tissue damage after mastectomy, breast augmentation, calvarial defects, Crohn’s fistulas, and damaged skeletal muscle.

Materials / method: 121 patients that were aected by the outcomes of breast oncoplastic surgery were treated with EF-e-A, comparing the results with the control group (n = 50) treated with not enhanced fat graft (EF-ne-A). The preoperative evaluation included a complete clinical examination, a photographic assessment, biopsy, magnetic resonance (MRI) of the
soft tissue, and ultrasound (US). Postoperative follow-up took place at two, seven, 15, 21, 36 weeks, and then annually.

Results: In 72.8% (n = 88) of breast reconstruction treated with EF-e-A, we observed a restoration of the breast contour and an increase of 12.8 mm in the three-dimensional volume after 12 weeks, which was only observed in 27,3% (n = 33) of patients in the control group that was treated with EF-ne-A. Transplanted fat tissue reabsorption was analyzed with instrumental MRI and US. Volumetric persistence in the study group was higher (70.8%) than that in the control group (41.4%) (p < 0.0001 vs. control group).

Conclusion: The use of EF-e-A was safe and eective in this series of treated cases.

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Objectives: Nowadays, some people regret having a breast augmentation surgery, considering their implants oversized and not natural looking. However, the decision of having a reduction procedure is not easy, due to the fact that it implies more skin scaring.

Introduction: Some patients would like to reduce their implant dimensions about one or two sizes without having a new scar. Considering the skin and muscle previously involved, this presents as a problem for the surgeon, who has to perform a technique without long or bigger scars.

Therefore, we have developed a new technique, which allows us to perform an easy and efficient implant volume reduction avoiding the scar consequences of a breast lift surgery.

Materials / method: To initiate, the breast area involved is infiltrated with a dilution of adrenaline and physiologic solution (1:10, 000). The next step is to perform an incision right at the same place where the previous scar has been made, allowing us to remove the previous scar completely.
The tissue is dissected up to the implant until the implant is released, removed and exchanged for a smaller size.

All the extra space left from the previous implant is sutured together in a circular fashion with Vicryl 1-0. Hemostasis is reviewed and a smaller implant is inserted.

Results: Continuing to close the pectoral muscle´s fibrosis capsule with the superficial fascia of the chest wall. There is no need to perform a capsulotomy.
Sometimes we create a pocket under the breast tissue, over the fascia muscle.

The nipple-areola complex is repositioned 1-2 cm above the original place in order to live it higher. When needed, we suture the nipple-areola complex at the central or side level with Monocryl 3-0.
At least, the skin is closed with Histoacryl glow.

Conclusion: The proposed technique allows breast reduction with smaller implants without increasing the number and size of scars, which is very pleasant for the patients, and requires less recovery time.
It also allows to relocate the crease of the breast and maintain the implant and tissue in the right position.

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