Expert guide: Aesthetic & Cosmetology 2015 16 June 2015 June 2015 17 breast. However I feel lipofilling is very useful for small secondary ad-justments to improve fullness of up-per pole or to give a bit more volume to reconstructed breast after recon-struction with DIEP or TUG flaps. Using fat grafting to resurface de-fects after wide local excision is not something that makes me feel at ease. There is ongoing broad re-search regarding safety of fat graft-ing. No strong evidence was provid-ed against fat transfer to breast tis-sue with previous history of breast cancer, neither there is enough evi-dence to prove the contrary. Inject-ing stem cells to the irradiated breast tissue after wide local excision know-ing that there is always risk of recur-rence is very different from injecting it to the area of complete mastecto-my where no breast tissue was left.Issue 5. New Exciting Horizons - Joined Breast Reconstruction and Lymphoedema Treatment.Following mastectomy and axillary lymph node clearance for breast cancer it is not uncommon for the woman to develop lymphoedema of her arm on the side of the can-cer. The exciting news is that now it is possible to perform an operation combining the breast reconstruc-tion using tissue taken from abdo-men (DIEP flap) with the restoration of removed axillary lymph nodes us-ing vascularized lymph node transfer (LNT) from the groin in order to si-multaneously rebuild the breast and treat the lymphoedema. The lymph nodes are transferred to the area af-fected by lymphoedema to restore lymphatic outflow. The blood ves-sels of the lymph nodes are joined under the microscope to recipient vessels. This allows the preservation of blood flow to the lymph nodes en-suring their survival in the new loca-tion. The newly transferred lymph nodes stimulate growth of new lym-phatic vessels thereby improving the lymphatic outflow circulation. If LNT is not enough additional lymphatico-united kingdom venular anastomosis (LVA) is performed small through 2-3 cm incisions, which are made on the skin of the patient’s extremity. The surgeon then looks for viable lymphatic vessels, which are generally less than 1 mm in diameter. These tiny channels are then connected under a high magnification micro-scope to very small veins using sutures, which are smaller than the human hair. This procedure creates new pathways, which then allow lymphatic fluid that has accumulated in the obstructed lymphatic system to divert into the venous system bypassing the obstruction. Fig 1.Patient 1.Patient had mastectomy and later on her breast was rebuilt with tissue from her abdomen (DIEP flap). No expander was inserted and the whole breast was recon-structed as a single unit using abdomi-nal tissue with very satisfactory cosmetic outcome.Patient 2.Patient had an expander inserted after mastectomy, which became painful, dis-placed and encapsulated, causing distress and discomfort to the patient for a long time. As a consequence of insufficient expansion there was no possibility to ex-pand the skin enough. Final result after reconstruction with DIEP flap is good, but the flap skin is inserted in the middle of the breast as opposed to the case 1.