**9. BR with lipofilling**

BR could be achieved by lipofilling (fat transfer) after mastectomy. This technique involves removing fat from certain areas in the body by way of liposuction, processing the fat cells, and transferring them to the area of absent breast. It is important to note that there is a limitation of how much fat can be injected in order for the fat cells to survive and often times this requires several sessions of fat grafting in order to obtain the desired result. Patients who undergo breast conserving therapy with lumpectomy resulting in a contour deformity or volume deficiency after excision, may benefit from fat transfer procedure in order to restore the loss of volume in the treated breast [39]. Of note, BR with lipofilling has been shown to be ontologically safe [40]. Advantages of lipofilling for breast reconstruction

#### **Figure 11.**

*BR with lipofilling. Left: Patient with history of NSM for left BC resulting in contour deformity. Right: patient after Reconstruction with 4 sessions of lipofilling and scar release.*

include the creation of a breast with a natural consistency, minimal scarring, could be use in patients with comorbidities, relatively simple procedure, and low costs [41]. The main limiting factor of this technique is that fat transfer uptake may require multiple fat grafting sessions [42]. This procedure is better offered to patients with small brassiere cup. Some teams report the use of a skin expansion with expander or an expansion device like BRAVA system [43]. Although BR with lipofilling is a relatively new technique, it is gaining in popularity in the United States and worldwide (**Figure 11**) [44].
