Reconstruction mammaire et lipomodelage : information, technique, précautions, images à connaître

Breast lipomodelling is a technique that consists in transferring fat where it is in excess, to the breast that is to be reconstructed. We elaborated this technique in 1998. We adapted it from the lipostructure technique, used in aesthetic facial surgery, which we transposed to breast reconstructive surgery. The lipomodelling technique was initially the subject of controversies, but is now acknowledged by the majority of French and International plastic surgeons. This technique was evaluated by the French competent authority responsible for health technology assessment (HAS : Haute Autorité de Santé), which issued a report in January 2015 that led to the reimbursement of this technique by the French health insurance system. This technique has numerous advantages: autologous tissue, reproducible results, minimally invasive, with very few complications, and giving very natural results. The disadvantages are: several lipomodelling sessions are generally needed for difficult cases; the learning curve; and finally, oedemas and bruises. The radiologist plays a major role in the oncological safety of this procedure, especially before performing a lipomodelling after breast conservative surgery. Preoperative imaging, adapted to the patient medical history, is necessary and must clearly state whether the surgery can be performed or not. Similarly, the postoperative follow-up must clearly define the normal aspects of cytosteatonecrosis, and the conclusion of postoperative imaging must be clear and unequivocal. When dealing with a suspicious lesion, a microbiopsy should be performed to exclude any underlying neoplasia.