LAUSR

Dear Sir, We thank Dr. Campiglio for his interest in our article [1]. ‘‘One stage mastopexy–lipofilling in cosmetic breast surgery: a prospective study’’ [2] and for his thoughtful comments on our study. We perform a prospective study with the aim to share our experience on this technique, describing our surgical technique and focusing on long-term esthetic results and patient-reported outcomes. The author underlines the importance of patient selection in order to determine the correct clinical indication for one stage mastopexy– lipofilling. Indeed, this technique allows for slight breast volume increase and acts more on breast shape. For this reason, we completely agree with Dr Campiglio and we think that patients should be adequately informed about the alternative options. Therefore, it seems important to us to reemphasize a key point concerning our paper: one stage mastopexy–lipofilling does not replace one stage mastopexy with implant placement. However, in our practice, there is a not negligible portion of patients who wish to modify the shape of the breast, obtaining a filling of the upper pole, without significant increases in the volume of the breast. With respect to simple mastopexy, in our hands the addition of lipofilling seems to bring advantages in terms of breast reshaping and breast volume distribution. Moreover, as stressed in our paper, the purpose of fat grafting is not only to improve breast contouring allowing for a filling of the upper poles and a better definition of the footprint but also to obtain a body shaping of donor site area. Another advantage of this technique not mentioned in our article, is the ability to better control slight preoperative asymmetries by playing with the amount of fat injected on both sides. In addition, in case of patients with favorable body habitus who refuse breast implant and who desire to increase more than one-cup size, a secondary lipofilling procedure can be preoperative planned. In our experience, autologous breast augmentation using fat graft is a valid procedure that allows for satisfactory results [3]. Regarding surgical technique, the main difference between our approach VS Dr Campiglio approach regards the fat injection phase. In our opinion, subfascial and intramuscular injection in pectoral major do not present the same risks of intramuscular injection in buttock augmentation and consent to maximize graft survival. To our knowledge, to date, no cases of fat embolism related to breast augmentation with fat grafting were reported in the literature [4]. Regarding the topographic strategies of fat injection, we overfill the upper poles (medial and lateral quadrant in equal proportion), and we also inject the inferior breast & Maria Lucia Mangialardi [email protected]