ASPS 2008: Fat Injections Can Improve Breast Reconstruction, Study Shows

Kathleen Louden

November 07, 2008

November 7, 2008 (Chicago, Illinois) — Autologous free fat grafting to the breast in 21 patients safely and effectively corrected defects in soft tissue and contour that resulted from postmastectomy reconstruction using an implant, a new study found.

"Patients were uniformly satisfied with the results, as well as the side benefit of abdominal 'liposuction'," said lead author Gregory R. Scott, MD, a plastic surgeon with Kaiser Permanente Medical Center, San Diego, California, referring to the fact that the fat was harvested from the abdomen in all patients. "Results have been very longstanding."

Follow-up ranged from 3 months to 5 years, he said in a phone interview with Medscape Dermatology.

The study findings were presented as a scientific poster here at Plastic Surgery 2008, the American Society of Plastic Surgeons (ASPS) Annual Meeting, where several oral presentations focused on the controversial procedure of fat grafting to the breast.

In some patients, postmastectomy tissue expansion and placement of an implant can result several months later in deformities, Dr. Scott said. In the new study, the most common indication for fat transfer was thin tissue coverage superior to the implant, called a superior perimeter defect, sometimes combined with wrinkling of the implant, according to the abstract. Three patients underwent the procedure primarily because of a tissue-contour deformity.

Dr. Scott performed 42 fat-transfer procedures. Eight women (38%) underwent unilateral fat transfer, and 13 (62%) had bilateral fat grafting an average of 9 months after implant placement (range, 2 - 44 months). Of the 21 patients, 7 (33%) had a second fat transfer later (mean, 8.5 months) because of initial undercorrection or personal preference.

The amount of fat transferred to the breast ranged from 30 to 180 mL (mean, 67 mL). Two patients had fat harvested from the thighs in addition to the abdomen. The investigators used the Coleman technique of autologous free fat transfer.

Safety Profile Good in This Study

The authors performed a retrospective chart review and evaluated the results. They did not score or otherwise objectively measure aesthetic results, but they did track complications.

Safety concerns about fat grafting include the amount of injected fat the body will absorb; the possibility of fat necrosis, especially with larger volumes of fat; and the potential for fat necrosis or calcification to obscure mammograms or be mistaken for cancer, experts at the meeting reported.

None of the patients in the new study experienced obvious fat necrosis or postoperative cellulitis or other infection, according to the abstract. However, a few patients had a pea-sized palpable cyst in the field of the fat transfer that was benign, Dr. Scott told Medscape Dermatology.

"The biggest risk of this procedure is the general anesthesia," he said.

More Research Needed

Because the researchers did not provide for third-party blinded observation of the results, they did not submit enough evidence to support their claim of efficacy and safety, countered Karol Gutowski, MD, chair of the ASPS Fat Grafting Task Force and a plastic surgeon with NorthShore University Health System, in Evanston, Illinois. He was not involved in the study.

"This study does not add to our knowledge base. We need the full paper to draw conclusions," he told Medscape Dermatology. "We also need large prospective studies on this issue."

Dr. Gutowski continued: "It's reasonable to consider fat transfer as an adjunct to breast reconstruction, but that doesn't mean we're recommending it."

While presenting at "The Science of Fat Transfer," panel, Dr. Gutowski said that the Fat Grafting Task Force completed a comprehensive review of the literature on fat grafting to the breast and will draft a guiding-principles document for ASPS members.

"There are encouraging preliminary study results, but they are backed up by low levels of evidence," he told the audience.

Another panel discussion, "Should We Inject Fat into the Breast?", brought a different opinion.

"Good data exist supporting fat grafting as a reconstructive adjunct," said William P. Adams Jr, MD, a panel presenter and a member of the ASPS Emerging Trends Committee. "This is a less controversial application than for breast augmentation because surgeons typically inject less fat volume than for augmentation."

Dr. Scott has disclosed no relevant financial relationships. Dr. Gutowski disclosed that he is a consultant for Angiotech, in Vancouver, British Columbia, which has an interest in fat-graft survival, and he consults for AMV Partners, which is working to develop a device that would improve fat grafting. Dr. Adams disclosed that he is an investigator for Allergan and Mentor and a consultant for Allergan and Ethicon. A member of his family has a financial interest in Genesis Biosystems Inc.

Plastic Surgery 2008: American Society of Plastic Surgeons (ASPS) Annual Meeting: Abstract P25. Presented November 4, 2008.

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