4675 Autologous Fat Grafting for Primary Breast Augmentation: A Critical Review of the Literature

Friday, May 6, 2011: 10:30 AM
James Rosing, MD1, Lee L.Q. Pu, MD, PhD2, Granger Wong, DDS, MD3 and Michael Wong, MD1, (1)Plastic & Reconstructive Surgery, UC Davis Medical Center, Sacramento, CA, (2)Plastic Surgery, University of Kentucky, Lexington, KY, (3)Plastic Surgery, UC Davis Medical Center, Sacramento, CA
Goals/Purpose:  As the technique of autologous fat grafting is being refined and perfected, its clinical applications are expanding.  The use of autologous fat grafting for primary breast augmentation is controversial because of a lack of clarity regarding its safety and efficacy.  In order to help surgeons gain insight on this subject, we conducted a systematical review of the current literature. 

Methods/Technique:  The MEDLINE database was searched using the terms “fat grafting” or “fat transplantation” and “mammaplasty”.  Our initial search included 115 articles.  Including the term “augmentation” focused the search to 37 articles.  We then manually selected 17 articles.  Grafting technique, clinical outcome, radiologic impact, and complications were carefully listed and compared in order to formulate summary statements.

Results/Complications: 7 articles focused on technique and outcome, 5 on radiologic impact, and 5 on specific complications.  Methodologies were limited to case series, retrospective reviews, and case reports.   

The lower abdomen and/or thigh were used as donor sites amongst 11/11 reporting authors.  4/11 authors used a manual harvest technique while 7/11 authors used mechanical liposuction for harvest.  Graft processing varied widely and included centrifugation, oscillating tables, decanting, and mixing with insulin or VEGF for stabilization of the graft.   

12 articles report mammographic findings.  Follow-up ranged from 1 month to 6 years.  9/12 mammographic findings were benign appearing calcifications easily discernable from the characteristic microcalfications associated with breast cancer.  3/12 describe microcalfication findings, however, no follow-up was reported.

Conclusion: Autologous fat grafting for primary breast augmentation may be considered.  Favorable long-term outcomes can be accomplished with a refined technique, although an optimal method is yet to be standardized. Fat grafting to the breast can be associated with complications such as oil cysts, fat necrosis, and calcifications. Such calcifications produce distinct radiologic features that may be readily discernable from breast cancer.

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