Defining Fat Necrosis in Plastic Surgery

Abstract

Based on the articles reviewed in this article, a more uniform definition needs to exist that is clearly defined in all articles that report on fat necrosis. The authors suggest defining fat necrosis as a palpable, discrete, and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination. Fat necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings. The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis into varying grades of severity to ultimately help guide clinical decision-making.

Myth-Busting the DIEP Flap and an Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review

“…Minor clinically detectable areas between 1 and 3 cm were found in 3.4 percent of standardized DIEP flaps and 2.4 percent of abdominal perforator exchange flaps (Tables 3 and 6). 2,3,5,6,9–17…”

“…Fat necrosis was defined as a palpable nodule greater than or equal to 1 cm according to the Rao grading system. 6…”

Predicting venous congestion before DIEP breast reconstruction by identifying atypical venous connections on preoperative CTA imaging

“…Fat necrosis incidence ranges from 5% to 35% (Kroll, 2000;Peeters, Nanhekhan, Van Ongeval, Fabre, & Vandevoort, 2009) and non-standardized definitions based combinations of clinical symptoms, signs, or imaging findings remain a challenge. (Rao & Saadeh, 2014) The flap periphery is typically affected, (Figus, Mosahebi, & Ramakrishnan, 2006) suggesting that distance from the vascular pedicle is a predisposing factor. Interestingly, medial row perforators are more likely to result in fat necrosis than lateral row perforators (24.5% vs. 8.2%; P < .001).…”

To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction

“…18 Currently, there is no clear consensus on how fat necrosis is defined or classified. 18,19 Due to our multi- surgeon experience, we felt that this was our most objective data for analysis. While the data suggests that there is a difference in fat necrosis requiring excision between the two cohorts, the reason for the difference is less clear.…”