The Use of Autologous Fat Transplantation to Remedy the Iatrogenic Lipoatrophic Effect of Tissue Expanders

Abstract

Introduction: Tissue expanders have become a popular modality in plastic and cosmetic surgery. Many victims of burns and severe trauma, premalignant lesions, congenital malformations, unwanted or regretted tattoos over large areas, women undergoing postmastectomy breast reconstruction, or men with extensive male-pattern alopecia may seek treatments that use tissue-expansion techniques. Tissue expansion has been an excellent tool for expanding normal skin to provide good quality, cosmetically appealing, full-thickness skin coverage of defective areas. However, like most treatment modalities, tissue expanders have some undesired pitfalls, sequelae, and complications associated with their use. We used autologous fat transplantation to remedy asymmetrical arm circumference after skin expansion on one arm and report our results in this case report. Case Report and Procedure: The patient is a 16-year-old female who presented with a congenital hairy nevus measuring 6.5 × 5.5 cm in the middle part of the posterolateral aspect of her left arm. Treatment included the use of tissue expanders, followed by excision of the nevus to treat the area. After the treatment, the patient complained that her left arm had become thinner than the right. Circumference of both arms measured at symmetrical points revealed a variance of 3 cm. Autologous fat transplant surgery, with a slight overcorrection that was expected to reduce over time, was offered as a solution. Conclusions: Autologous fat transplantation can be used as an adjunct to tissue expansion to fill the lipo-atrophic defects that may result from tissue expansion. Results: Postoperative follow up revealed sound healing of the wound. Her left arm circumference decreased over the following 6 weeks postoperatively (the overcorrection). The final result was symmetrical arms, both visually and numerically.