Page 128 - Read Online

Table 2: Source of fat for grafting can lead to suboptimal cosmetic results. Fat injection
Site Frequency (%) is a powerful tool that provides surgeons the ability to
achieve esthetically superior results. Meticulous technique
Medial thighs 20.5 and proper planning, particularly assessing the recipient
Flanks 39.1 site and limiting injection volumes, allows surgeons to
Thighs + flanks 2.7 deliver results with low complication rates.
Abdomen 21.9
Trochanters 13.3
Medial knees 2.7 REFERENCES
1. Chajchir A, Benzaquen I. Liposuction fat grafts in face wrinkles and hemifacial
Table 3: Initial type of breast reconstruction atrophy. Aesthetic Plast Surg 1986;10:115‑7.
2. Chajchir A, Benzaquen I. Fat‑grafting injection for soft‑tissue augmentation.
Type of surgery Frequency (%) Plast Reconstr Surg 1989;84:921‑34.
Expander-implant 62.0 3. Ellenbogen R. Free autogenous pearl fat grafts in the face: a preliminary
DIEP 24.1 4. report of a rediscovered technique. Ann Plast Surg 1986;16:179‑94.
Report on autologous fat transplantation. ASPRS Ad‑hoc Committee on New
Latissmus dorsi 4.8 Procedures, September 30, 1987. Plast Surg Nurs 1987;7:140‑1.
Lumpectomy defect 7.0 5. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and
TRAM 2.1 efficacy. Plast Reconstr Surg 2007;119:775‑85.
6. Kling RE, Mehrara BJ, Pusic AL, Young VL, Hume KM, Crotty CA, Rubin JP.
DIEP: Deep inferior epigastric perforator, TRAM: Transverse rectus Trends in autologous fat grafting to the breast: a national survey of the
abdominis myocutaneous
American society of plastic surgeons. Plast Reconstr Surg 2013;132:35‑46.
7. Delay E, Garson S, Tousson G, Sinna R. Fat injection to the breast: technique,
Despite having experienced few complications, all results, and indications based on 880 procedures over 10 years. Aesthet Surg J
patients with a suspicious lesion or nodule were 8. 2009;29:360‑76.
Gutowski KA, ASPS Fat Graft Task Force. Current applications and
encouraged to follow-up with their breast surgeon and safety of autologous fat grafts: a report of the ASPS fat graft task force.
oncologist. [8,11] Fortunately, radiographic evaluation can Plast Reconstr Surg 2009;124:272‑80.
reliably distinguish calcifications, fat necrosis and oil cysts 9. Cotrufo S, Mandal A, Mithoff EM. Fat grafting to the breast revisited: safety
from malignant lesions. [4] and efficacy. Plast Reconstr Surg 2008;121:701.
10. Mu DL, Luan J, Mu L, Xin MQ. Breast augmentation by autologous fat injection
The complications identified in our patients occurred only grafting: management and clinical analysis of complications. Ann Plast Surg
2009;63:124‑7.
in radiated breasts. Despite the paucity of data regarding 11. Walden JL. Complications after autologous fat injection to the breast. Plast
fat injection in radiated breasts, there is evidence Reconstr Surg 2009;124:326‑7.
demonstrating the success of fat injection into radiated 12. Choi M, Small K, Levovitz C, Lee C, Fadl A, Karp NS. The volumetric
tissue. While prior radiation may be a risk factor for analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg
[14]
fat necrosis, it appears that lipoinjection alleviates the 2013;131:185‑91.
damage associated with radiation. [15,16] Clearly, further 13. Kanchwala SK, Glatt BS, Conant EF, Bucky LP. Autologous fat grafting to
the reconstructed breast: the management of acquired contour deformities.
studies are needed to elucidate the advantages and Plast Reconstr Surg 2009;124:409‑18.
pitfalls of fat injection in radiated breasts. 14. Phulpin B, Gangloff P, Tran N, Bravetti P, Merlin JL, Dolivet G. Rehabilitation
of irradiated head and neck tissues by autologous fat transplantation. Plast
It is important to point out that familiarity with the Reconstr Surg 2009;123:1187‑97.
technical aspects of fat injection affects the incidence 15. Sultan SM, Stern CS, Allen RJ Jr, Thanik VD, Chang CC, Nguyen PD,
of complications. [7,8] While the incidence of fat necrosis Canizares O, Szpalski C, Saadeh PB, Warren SM, Coleman SR, Hazen A.
and graft resorption is reduced when small aliquots are Human fat grafting alleviates radiation skin damage in a murine model. Plast
Reconstr Surg 2011;128:363‑72.
injected in multiple tissue planes, there is evidence that 16. Salgarello M, Visconti G, Farallo E. Autologous fat graft in radiated tissue
the long-term viability is increased with greater overall prior to alloplastic reconstruction of the breast: report of two cases. Aesthetic
injection volumes. [10,12,17] Plast Surg 2010;34:5‑10.
17. Khonji N. Breast reconstruction using autologous fat. Br J Surg 2010;97:795‑6.
A discussion on the safety of fat injection would not 18. Petit JY, Botteri E, Lohsiriwat V, Rietjens M, De Lorenzi F, Garusi C,
be complete without addressing the potential effects of Rossetto F, Martella S, Manconi A, Bertolini F, Curigliano G, Veronesi P,
lipoinjection on local breast cancer recurrence. The increase Santillo B, Rotmensz N. Locoregional recurrence risk after lipofilling in breast
cancer patients. Ann Oncol 2012;23:582‑8.
in vascularity promoted by injected adipose tissue may 19. Petit JY, Rietjens M, Botteri E, Rotmensz N, Bertolini F, Curigliano G, Rey P,
present a theoretical risk for recurrence. A study by Petit Garusi C, De Lorenzi F, Martella S, Manconi A, Barbieri B, Veronesi P, Intra M,
[17]
et al. [18,19] describes early follow-up data suggesting that Brambullo T, Gottardi A, Sommario M, Lomeo G, Iera M, Giovinazzo V,
fat grafting does not present an increased risk for cancer Lohsiriwat V. Evaluation of fat grafting safety in patients with intraepithelial
neoplasia: a matched‑cohort study. Ann Oncol 2013;24:1479‑84.
recurrence, however, a follow-up cohort study by the same 20. Pérez‑Cano R, Vranckx JJ, Lasso JM, Calabrese C, Merck B, Milstein AM,
author suggests that the risk for recurrence could increase Sassoon E, Delay E, Weiler‑Mithoff EM. Prospective trial of adipose‑derived
in women with high-grade intraepithelial neoplasia under regenerative cell (ADRC)‑enriched fat grafting for partial mastectomy defects:
the age of 50. An additional study funded by The Plastic the RESTORE‑2 trial. Eur J Surg Oncol 2012;38:382‑9.
Surgery Foundation is ongoing to further evaluate the 21. Khouri RK, Eisenmann‑Klein M, Cardoso E, Cooley BC, Kacher D, Gombos E,
Baker TJ. Brava and autologous fat transfer is a safe and effective breast
oncologic safety of fat grafting in breast cancer patients. augmentation alternative: results of a 6‑year, 81‑patient, prospective
multicenter study. Plast Reconstr Surg 2012;129:1173‑87.
In conclusion, contour irregularities are common 22. Rubin JP, Coon D, Zuley M, Toy J, Asano Y, Kurita M, Aoi N, Harii K,
problems associated with breast reconstruction and Yoshimura K. Mammographic changes after fat transfer to the breast

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