A “Solid Injection Method” to Reduce Postoperative Complications in Autologous Fat Grafting for Breast Augmentation

Abstract

Introduction: Over the last decades, there has been an increasing interest in breast augmentation using autologous fat transplantation for reconstructive and cosmetic purposes. However, autologous fat graft to the breast is not a simple procedure and should be performed only by well-trained and skilled surgeons. The rate of postoperative complications is reported in the literature to be 10–16.7%. To reduce complications in autologous fat graft to the breast, the author developed a solid injection method to increase the contact area of the grafted fat and the recipient tissue. Materials and Methods: From May 2010 to February 2012, we performed autologous fat grafting for 281 patients. After exclusion of the patients with inadequate follow-up time (<6 months) or who were lost to follow-up, 190 patients were enrolled in this study. The enrolled patients were randomly divided into group A, in which structural fat grafting was done by the method described by Coleman, and group B, in which the solid injection method was administered. For the solid injection method, the operator used his nondominant hand to compress the breast to increase the contact area with the injected fat when performing the fat graft injection. At the end of the fat injection, the breasts were still soft, and there was no pressure leakage from the entries. The data between the 2 groups was analyzed using a two-sample t test, and the complication rates were analyzed using a chi-square test. Results: The age of the patients ranged from 21 to 57 years (mean = 34 years). The volume of fat harvested was 776 mL to 5050 mL (mean = 1593 mL), and the volume of fat grafted to each breast was 120 to 310 mL (mean = 246 mL). There were 56 patients enrolled in group A and 134 patients enrolled in group B. All patients were followed up from 7 to 28 months, with an average of 15.1 months postoperatively. The differences of patient data in both groups were statistically insignificant. Postoperative complication rates were 14.2% in group A and 2.2% in group B, the difference of which is statistically significant (P = .001). Conclusions: The solid injection method can reduce postoperative complications in autologous fat grafting. There were 4 principles to be followed in this method: Principle I, the fat should be injected only into an area with “solid” feedback while processing the injection; Principle II, the fat should never be injected into an empty area; Principle III, the breasts should be soft at the end of injection; and Principle IV, there should be no/minimal pressure leakage from the entries after the injection.

Reconsidering cell-assisted lipotransfer for breast augmentation: effect of stromal vascular fraction enrichment on graft survival assessed with 3-dimensional laser scanning

“…Few studies have addressed the operation time for breast augmentation with fat grafting. It was previously reported that an additional operation time of around 2 hours was needed for CAL breast augmentation [33]. In our study, an additional 30 minutes was necessary for SVF isolation if the procedure of graft preparation was performed by an expert other than the surgeon.…”

Autologous fat grafting in breast augmentation: A systematic review highlighting the need for clinical caution

“…There were 15 prospective studies, 8,[10][11][12][13][14]18,[22][23][24]28,30,31,35,39 17 retrospective studies, 6,7,9,16,17,20,21,[25][26][27][32][33][34][35][36][37]40 and three randomized controlled trials. 29,38,41,43 A total of 3757 women were included, and the mean age was 40.5 years (range, 17 to 78 years). The mean follow-up period was 24.5 months (range, 1 to 372 months).…”

“…Following full-text screening, 58 articles were excluded for study design, interventions, and/or outcomes not of interest, and 35 articles were included. 6–14,16–18,20–42 The included studies’ characteristics are shown in Table 1. There were 15 prospective studies, 8,10–14,18,22–24,28,30,31,35,39 17 retrospective studies, 6,7,9,16,17,20,21,25–27,32–37,40 and three randomized controlled trials.…”

“…Complications were reported in 20 studies 6,7,10,12,14,18,[20][21][22][23][24][25]27,29,30,33,[36][37][38]42 ; the overall complication rate was 27.8% (Table 3). The most common benign findings included fat necrosis, indurations, and oil cysts.…”

“…Nineteen studies assessed radiologic changes with AFG (total, n = 2263), nine studies 9,10,13,22,27,31,36,38 assessed imaging preoperative and postoperatively, and 10 studies [6][7][8]12,14,23,24,28,29,43 assessed imaging postoperatively only (Table 4). New radiologic changes were reported in four of nine studies (n = 784) that compared preoperative and postoperative imaging.…”