New study on fat grafting to the breast

It’s seems like a perfect answer – “take a little off down here, put some a little more up here”. But fat grafting to the breasts has been controversial. A problem, known as fat necrosis, has been the #1 concern. Lumpy deposits of injected fat, which may feel exactly like a breast cancer, can result if the fat does not survive the transfer, and goes on to form calcified scar tissue within the breast.

Previously, back when radiologic imaging of the breast was less advanced, sorting these lumps of scar out from early breast cancers was a real problem. Surgical biopsies were sometimes needed to make the determination. Over the last decade, though, a lot of work has been done on fat grafting, reappraising its role as a reconstructive tool. Here in the U.S., Drs. Coleman and Khouri, two plastic surgeons who have been independently making major contributions to this area, deserve a lot of credit.

In this month’s issue of the Aesthetic Surgery Journal is an important study looking at the safety of fat injection to the breast. This work, from Lyon, France, summarizes 880 procedures over 10 years, and mainly looks at the application of fat grafting for reconstructive applications – following mastectomy reconstruction, and for breast asymmetries and other developmental problems.

The French group in the study used Dr. Coleman’s technique (low-pressure small cannula liposuction of the fat from the donor area, purifying the fat with a centrifuge, then injecting it in very small volumes into the target area). None of the more advanced techniques that have been recently reported to enhance fat grafting success were used -i.e. no addition of stem-cells, or use of the external BRAVA suction device.

Very careful breast imaging was mandatory – both pre-op and at one year post-procedure, using mammograms, ultrasound and MRI. The French radiologists “signed off” on the normal status of the exams before the patient underwent surgery. (I wonder if any lawsuit-averse U.S. radiologists would be willing to do that!) While all patients had some post-surgical changes in their post-op mammograms, the radiologists were, in general, able to sort out these changes with the use of the more advanced imaging methods and a lot of experience.

Ninety percent of the results were rated as either “good” or “very good”. As expected, the surgeons found that about 40% of the injected fat melted away. Fat necrosis – formation of lumpy scar tissue – was seen in 15% of the authors first 50 cases, decreasing to about 3% after that. In some cases, a needle biopsy of the lumps in the breast was still required.

Overall, good improvements in the breast contour and degree of symmetry were reported, and the authors felt that fat grafting represented a very good technique for “touching-up” results after a complex breast reconstruction, or avoiding a more-complex reconstructive method. They also showed nice results for breast asymmetry and cases of Poland’s syndrome, a developmental breast problem.

Bottom line: fat-grafting to the breast is a procedure which, while very promising, is still under development. Guidelines about timing, indications, pre-op and post-op MRI imaging, and important details regarding the best technique are still being sorted out. I can not yet recommend it for cosmetic breast enlargment at this stage, outside of a carefully controlled clinical trial.

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