Sequelae of fat grafting postmastectomy: an algorithm for management of fat necrosis (original) (raw)
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Differentiating Fat Necrosis from Recurrent Malignancy in Fat-Grafted Breasts
Plastic & Reconstructive Surgery, 2012
A utologous fat grafting is an increasingly popular technique with which to improve aesthetic outcomes in breast reconstruction. First described by Czerny in 1895, fat transfer to the breast was infrequent until a rapid renewal of interest occurred in the early 1980s. 1-4 Today, fat grafting is frequently used for breast augmentation and to correct contour deformities in autologous and prosthetic breast reconstruction. 5-10 However, significant controversy regarding the safety of fat grafting has mirrored significant advancements in its application. In 1987, the American Society of Plastic Surgeons released a position paper stating the following: "The committee is unanimous in deploring the use of autologous fat injection ... the known physiological response to necrosis of this tissue is scarring and calcification. As a result, detection
Radiological findings in mammary autologous fat injections: A multi-technique evaluation
Clinical Radiology, 2013
from mammary autologous fat injections (lipofilling). MATERIALS AND METHODS: Informed consent and institutional review board approval were obtained. From January 2008 to December 2010, all patients that had undergone breast lipofilling at our institution (Catholic University) were consecutively enrolled. The site and amount of autologous fat injections were known. Mammography, ultrasonography, and magnetic resonance imaging (MRI) were prospectively obtained preoperatively, and 6 and 12 months after the procedure. Normal and pathological findings were described. RESULTS: Twenty-four patients (mean age 50.8 AE 10.5 years; range 26e70 years) were included. Fourteen patients underwent lipofilling after mastectomy, eight after wide local excision, one as a treatment for a congenital asymmetry, and one as a treatment for Poland syndrome. No severe complications were observed after treatment. Normal findings due to lipofilling ("oil cysts") were identified in 23 cases using ultrasound and in 16 using MRI. Liponecrosis, the most frequently observed complication, was detected in four cases using ultrasound and in eight by MRI. In one case mammography showed calcific fat necrosis. Mean amount of fat injected was 114.8 AE 55 ml. The average amount of fat grafted in patients who developed liponecrosis was 158.4 AE 42.7 versus 104.6 AE 52.3 ml (p ¼ 0.0043, t-test). In one case breast cancer recurrence was diagnosed. CONCLUSION: Normal findings due to lipofilling are better identified by ultrasound, and pathological findings are best identified using MRI. Liponecrosis most frequently occurs when large amounts of fat are injected. In the authors' experience lipofilling does not interfere with breast cancer early diagnosis.
The use of autologous fat grafts in breast surgery: A literature review
Archives of Plastic Surgery
Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.
Mammographic Changes after Fat Transfer to the Breast Compared with Changes after Breast Reduction
Plastic and Reconstructive Surgery, 2012
Background: One issue in the adoption of autologous fat transfer to the breast is concern over mammographic changes that may obscure cancer detection. The authors compared mammographic changes following fat grafting to the breast with changes seen after breast reduction. Methods: Twenty-seven women who had normal preoperative mammograms were treated with fat grafting to the breast, including admixing of autologous adipose stem cells with the fat graft, for cosmetic augmentation. Repeated mammograms were performed 12 months after surgery. As a control group, postsurgical mammograms from 23 reduction mammaplasty patients were compared. Eight academic breast imaging radiologists reviewed each mammogram in a blinded fashion. Outcomes analysis accounting for individual radiologist's tendencies was performed using generalized estimating equations. Results: The average volume of fat injected per patient was 526.5 cc. Fifty mammograms (27 lipotransfer, 23 breast reduction) were assessed. Differences in interpretation among individual radiologists were consistently observed (p Ͻ 0.10). Differences in abnormality rates were nonsignificant for oil cysts, benign calcifications, and calcifications warranting biopsy. Scarring (p Ͻ 0.001) and masses requiring biopsy (p Ͻ 0.001) were more common in the reduction cohort. Breast Imaging Reporting and Data System scores were higher after breast reduction (p Ͻ 0.001). Significant differences in the recommended follow-up time were also seen (p Ͻ 0.01). Conclusions: Compared with reduction mammaplasty, a widely accepted procedure, fat grafting to the breast produces fewer radiographic abnormalities with a more favorable Breast Imaging Reporting and Data System score and less aggressive follow-up recommendations by breast radiologists. (Plast.
Plastic and Aesthetic Research, 2015
Aim: Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction. The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction. Methods: A single surgeon, prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was reviewed. Patient characteristics, breast history, type of breast reconstruction, volume of fat injected, and complications were analyzed. Results: One hundred and twenty-four patients benefted from autologous fat injection from January 2008 to November 2013, for a total of 187 treated breasts. The patients were on average 49.3 years old (± 8.9 years). Fat was harvested from the medial thighs (20.5%), fanks (39.1%), medial thighs and fanks (2.9%), trochanters (13.3%), medial knees (2.7%), and abdomen (21.9%). An average of 49.25 mL of fat was injected into each reconstructed breast. A total of 187 breasts in 124 patients were lipo-infltrated during the second stage of breast reconstruction. Thirteen breasts (in 12 separate patients) were injected several years after having undergone lumpectomy and radiotherapy. Of the 187 treated breasts, 118 were reconstructed with expanders to implants, 45 with deep inferior epigastric perforator faps, 9 with latissimus dorsi faps with implants, 4 with transverse rectus abdominis myocutaneous faps, and 13 had previously undergone lumpectomy and radiotherapy. Six complications were noted in the entire series, for a rate of 3.2%. All were in previously radiated breasts. Average follow-up time was 12 months (range: 2-36 months). Conclusion: Fat injection continues to grow in popularity as an adjunct to breast reconstruction. Our experience demonstrates a low complication rate as compared to most surgical interventions of the breast and further supports its safety in breast reconstruction. However, caution should be used when treating previously radiated breasts.
Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study
BMC Cancer, 2021
BackgroundAlthough fat necrosis is a minor postoperative complication after breast reconstruction, occasionally it mimics to tumor recurrence in patients with breast cancer. Therefore, the surgeon should distinguish between benign fat necrosis and true local recurrence. The authors evaluated the clinical characteristics of fat necrosis after breast reconstruction and investigated the natural course of fat necrosis.MethodsBetween 2007 and 2013, a total of 362 patients underwent breast reconstruction after partial or total mastectomy for breast cancer in Kyungpook National University Hospital. Clinicopathologic characteristics and the occurrence of fat necrosis were assessed during surveillance for 10 years of mean follow-up period.ResultsThere were 42 cases (11.6%) of fat necrosis after breast reconstruction with partial or total mastectomy which were confirmed by needle or excision biopsy. The fat necrosis was resolved after a mean period of 45.9 months (SD, ± 42.1) and 26 cases (61...
Fat necrosis: A consultant’s conundrum
Frontiers in Oncology
Fat necrosis of the breast is a benign non-suppurative inflammation of the adipose tissue and often mimics breast cancers, posing a diagnostic challenge for the clinician and radiologist. It has a myriad of appearances on different imaging techniques, ranging from the pathognomic oil cyst and benign dystrophic calcifications to indeterminate focal asymmetries, architectural distortions, and masses. A combination of different modalities can assist a radiologist in reaching a logical conclusion to avoid unnecessary interventions. The aim of this review article was to provide a comprehensive literature on the various imaging appearances of fat necrosis in the breast. Although a purely benign entity, the imaging appearances on mammography, contrast-enhanced mammography, ultrasound, and magnetic resonance imaging can be quite misleading, especially in post-therapy breasts. The purpose is to provide a comprehensive and all-inclusive review on fat necrosis with a proposed algorithm allowin...
A case controlled study of the oncological safety of fat grafting
Plastic and Reconstructive Surgery, 2015
at grafting to the breast fulfills an increased clinical demand for a biocompatible filler in contour refinement, volume adjustment, and tissue rejuvenation in both cosmetic and reconstructive procedures, and has been used for total breast reconstruction. 1-5 Although many clinical studies have reported on the efficacy of fat grafting for breast cancer patients in terms of its various indications, 2,6-9 technical advancements,