Robert Whitfield MD describes European (Belgian) approaches to breast reconstruction using staged fat transfer ("lipo-filling") after placement of a tissue expander, noting they perform repeated office-based fat transfers over time and face different regulatory/insurance environments than the United States. He contrasts that with the DIEP free flap breast reconstruction (using abdominal skin and fat with preserved blood vessels and nerves) which he used predominantly and notes it can provide better sensation.
Chapters
So in Belgium, there was a group that used to present a lot of data about doing fat transfers, or lipo filling, as it is referred to in Europe, in a staged approach after placement of a tissue expander. So a tissue expander for everybody listening, is a temporary device that you can fill through a port and that expands the skin and the tissues there, so it stretches it out. And then you can put fat in between the, the skin and the capsule that forms around that device. So that was a method that they had been talking about since the first time I went to Barcelona in 2000, maybe five. And so we would use that technique not to the degree that they did, because they had more flexibility to say, okay, Petra wants to just have a fat transfer and that's the only method she chooses. So we're going to replace the tissue expander and then slowly withdraw the fluid over time and replace that volume, if you will, with another fat transfer. So they would do it every whatever, six months or something in the office, and they were in Belgium, so they had different rules and standards for an office based fat transfer, which we could never do in the United States. We would have to do it all under local or you'd have to have credentialing for your office. But nonetheless, they don't have to deal with insurance. So all the things that make it easier. But. So that's one method. I have had patients also choose to do the DIEP free flat breast reconstruction. That's what I used to do predominantly, which is taking the tissue, the skin and fat of the abdomen that's normally discarded in a tummy tuck, preserving the blood vessels and the nerves to it and then transferring that. And you can make them sensory so you'll have more sensation. Many groups do that in Europe, both in Germany and Belgium, and I don't know all the groups around, but it's practiced routinely.
