Autologous Fat Graft in the Reconstructed Breast: Fat Absorption Rate and Safety based on Sonographic Identification

Abstract

BackgroundAutologous fat graft has become a useful technique for correction of acquired contour deformity in reconstructed breasts. However, there remains controversial regarding the efficacy and safety of the practice for reconstructive breast surgery.MethodsA retrospective review was performed on 102 patients who had secondary fat grafting after breast reconstruction. Fat harvest, refinement and injection were done by Coleman's technique. All patients were followed up postoperatively within 1 month and after 6 months including physical examination and ultrasonography. In 38 patients, the reabsorption rate was calculated by serial changes of thickness between skin and pectoral fascia in the ultrasonic finding. Locoregional recurrence rate was compared with control group of 449 patients who had breast reconstruction without fat graft in the same time period.ResultsAverage 49.3 mL fat was injected into each breast. The most common location of fat graft was upper pole, followed by axilla, lower and medial breasts. During 28.7 months of average follow-up period, 2.9% of total patients had symptoms of palpable mass on fat graft side and ultrasonography identified fat necrosis and cyst formation in 17.6% of the patients. Calculated fat reabsorption rate was 32.9%. Locoregional recurrence was occurred in 1 patient (0.9%) and the rate was not different significantly with control group (2%).ConclusionsAlthough further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting, we propose autologous fat graft is an efficient and safe technique for secondary breast reconstruction.

Meta-analysis of the oncological safety of autologous fat transfer after breast cancer

“…Gale et al 32 Krastev Fertsch et al 31 Gale et al 32 26 Kim et al 40 Kronowitz et al 42 Laporta et al 44 Masia et al 47 Mestak et al 50 Pinell-White et al 61 Seth et al 68 Stumpf et al 71 Mestak et al 49 Stumpf et al 71 RE model (I 2 = 41·00%)…”

“…Cohen et al 26 Kim et al 40 Kronowitz et al 42 Laporta et al 44 Masia et al 47 Pinell-White et al 61 Seth et al 68…”

Shaped versus Round Implants in Breast Reconstruction: A Multi-Institutional Comparison of Surgical and Patient-Reported Outcomes

“…Two common indications for fat grafting in prosthetic breast reconstruction are upper pole hollowing and rippling. 7,27,28 Because shaped implants have a structural extension into the upper pole, resulting in a less abrupt transition, and are less prone to rippling because of their firmer composition, patients with this type of implant may require fat grafting less frequently.…”

Modifying alginate with early embryonic extracellular matrix, laminin, and hyaluronic acid for adipose tissue engineering

“…The major drawback for autologous fat grafting is unpredictable volume reduction ranging from 20% to 80% due to resorption or necrosis . Necrosis of grafted adipocytes may lead to inflammation, cyst formation, even calcification, and interferes with the surveillance of breast cancer through mammography . Graft survival may be enhance with increased vascularization, the presence of adipose stromal cells, and the use of supporting matrix, although the underlying molecular mechanism is not well understood .…”

“…6,7 Necrosis of grafted adipocytes may lead to inflammation, cyst formation, even calcification, and interferes with the surveillance of breast cancer through mammography. 8,9 Graft survival may be enhance with increased vascularization, the presence of adipose stromal cells, and the use of supporting matrix, although the underlying molecular mechanism is not well understood. [10][11][12] To develop ways to enhance the outcome of autologous fat grafting, various biomaterials have been tested in adipose tissue engineering both as cell carrier and as supporting matrix.…”