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have since enhanced the clinical utility of fat grafting, and 10 patients, measure fat grafting in a clinical context, and
autologous fat injection is now commonly used to correct include outcomes and complications [Table 1].
breast defects. [5,6]

To date, retrospective studies have shown that complications RESULTS
associated with fat injection markedly decreased with the
evolution of fat grafting protocols. [7,8] Calcification and fat One hundred and twenty-four patients benefited from
necrosis have been shown to correlate with the volume, autologous fat injection from January 2008 to November
as well as the technique of fat injection. [9-11] There is also 2013, for a total of 187 treated breasts. The patients were
evidence that the volume injected correlates with survival on average 49.3 years old (± 8.9 years). Fat was most often
of the grafted fat. The minimally invasive nature of the harvested from the medial thighs (20.5%), flanks (39.1%),
[12]
procedure allows patients to benefit from autologous medial thighs and flanks (2.9%), trochanters (13.3%),
tissue rather than foreign materials. As such, fat grafting medial knees (2.7%), and abdomen (21.9%). An average of
has evolved into a safe procedure to correct contour 49.25 mL (ranging from 8 to 210 mL) of fat was injected
deformities in the reconstructed breast. [7] into each reconstructed breast [Table 2].
Although some controversy remains with regards to the A total of 174 breasts in 112 patients were injected
benefits and risks of autologous fat injections, it is widely with autologous fat during the second stage of breast
used by reconstructive plastic surgeons to correct contour reconstruction. Thirteen breasts (in 12 separate patients)
[6]
deformities in breast reconstruction. Our experience were injected after having undergone lumpectomy
suggests this is a safe procedure that provides significant and radiotherapy. Eight breasts (in 5 separate patients)
improvement to breast contour following reconstruction. underwent a second round of fat injection 6 months after
This study describes a Karl Schwarz (KS) experience with the initial lipoinjection. Of the 187 treated breasts, 118
fat injection to correct contour deformities during breast were reconstructed with expanders to implants, 45 with
reconstruction. deep inferior epigastric perforator (DIEP) flaps, 9 with
latissimus dorsi flaps with implants, 4 with transverse
METHODS rectus abdominis myocutaneous flaps [Table 3]. Thirteen
of the breasts had previously undergone lumpectomy and
Patient population radiotherapy. Representative images of patients treated
The present study was approved by the McGill University with autologous fat grafting are shown in Figures 3 and 4.
Health Centre Ethics Board. A Karl Schwarz (KS), prospectively Six complications in 3 separate patients were noted in
maintained database of patients who underwent autologous the entire series, for a rate of 3.2%. All were in previously
fat injection during breast reconstruction from January 2008 radiated breasts. One patient developed an isolated
to November 2013 at McGill University Health Center was area of fat necrosis but also an occult pneumothorax
reviewed. Patient characteristics, breast history, type of breast treated conservatively. One patient developed a cellulitis
reconstruction, volume of fat injected, and complications treated successfully with antibiotics, and another patient
were analyzed retrospectively. developed an infection that was drained with a pig-tail
Technique catheter. Oil cysts were noted in 3 breasts.
Autologous fat was harvested using previously described
techniques. Donor sites included medial thighs, DISCUSSION
[13]
flanks, trochanters, arms, or abdominal subcutaneous
fat. Under sterile conditions, fat was harvested using Our experience suggests that autologous fat injection
the Tulip liposuction system (Tulip Medical Products, is a safe and effective procedure for correcting contour
San Diego, CA) with a 3 mm cannula. No donor site deformities following breast reconstruction. Of the 187
morbidity was observed in any of the patients enrolled treated breasts in our study, we identified complications
in this study. The fat was then purified on large Telfa in only 6 patients for a complication rate of 3.2%. It
Pads (Covidien, Mansfield, MA) as previously described should be noted that each of these complications
by Kanchwala et al. Once the fat reached a custard-like occurred in previously irradiated breasts, which have
[13]
consistency, it was loaded into 10-mL syringes [Figure 1]. been associated with impaired healing secondary due to
Based on preoperative topographic markings, fat was then radiation damage. Although our reported rates of fat
[5]
injected into the breasts in 1 mL aliquots, distributing it necrosis and oil cysts are low in nonradiated breasts, it
evenly in multiple tissue planes, using multiple passes, to must be noted that they only represent those discovered
visibly correct the previously present contour deformity on physical exam. It is likely that radiographic evaluation
[Figure 2]. would yield higher rates.

Review of the literature Assessment of the literature and the data presented
As a measure of comparison with previously published in this article suggest that fat injection can be a safe
studies, we conducted a literature search of the PubMed procedure. Although the studies reviewed demonstrate
database using the keywords “fat graft breast” in PubMed. significant variability among complication rates, our 6
Our search yielded 149 articles, of which 12 met our complications in 187 treated breasts lies on the lower end
inclusion criteria requiring that the studies enroll at least of the spectrum.

116 Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015