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Fat graft survival is comparable regardless of the breast reconstruction method.
Mihye Choi, MD, Kevin H. Small, MD, Chaya Levovitz, BS, Christina Lee, BA, Nolan Karp, MD.
New York University, New York, NY, USA.
Purpose
Secondary refinements for the reconstructed breast are routine procedures as plastic surgeons along with patients continue to desire better and more natural results. Autologous fat grafting (FG) has become an important option for correcting these deficiencies in volume and overall shape for the reconstructed breast. Previous short-term studies have reported approximately fifty percent volume retention after fat transfer to the breast but have not answered whether the type of breast reconstruction affects retention outcomes. The following study applies 3D imaging to assess the stability of the breast volume following secondary autologous fat grafting in various recipient sites: implant breast reconstruction, breast lumpectomy defects, and autologous breast reconstruction.
Methods
All patients receiving fat grafting to the reconstructed breast from 2009-2010 were enrolled in the study. FG surgery was performed using a modified Coleman technique to achieve symmetry. The locations for contour improvements and additional volume varied between all quadrants. Preoperative and post-operative 3D scans at three months were obtained on all patients. 3D imaging was performed using the Canfield VECTRA system and analyzed using Geomagic software. As previously described, breasts were isolated as closed objects and total breast volume was calculated on every scan.
Results
In the observed time period, total 116 patients underwent fat grafting for secondary breast reconstruction. Sixty-two implant breast reconstruction patients, fourteen breast lumpectomy patients, and forty autologous breast reconstruction patients received autologous fat transfer and were studied by three-dimensional images preoperatively and postoperatively. Average fat injected to the breast was 100cc. At 3 months postoperatively, the implant subset had 42 percent volume retention and resorption rate of 0.41cc/day. For the lumpectomy subset, the breast had 42 percent volume retention and resorption rate of 0.45cc/day. For the autologous subset, the breast had 44 percent volume retention and resorption rate of 0.55cc/day. No statistical difference was found between the three groups.
Conclusions
Fat grafting for secondary breast reconstruction is an essential tool to refine breast contour and volume, and the concept has grown in popularity due to ease of use, low morbidity and improvement in aesthetic outcomes. Our data suggests that breast reconstruction type does not affect percent volume retention and resorption rate. Long-term studies are needed to assess the stability of the breast after autologous fat transfer.
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