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American Association of Plastic Surgeons

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A Management Algorithm For Palpable Nodules After Fat Grafting To The Breast
Rachita Sood, MD, Megan Fracol, MD, Yuyang Chu, BA, Yufan Yan, BS, Lauren Feld, BS, Wen-Kuan Chiu, MD, John Y.S. Kim, MD, FACS.
Northwestern Memorial Hospital, Chicago, IL, USA.

Purpose
Nodule formation is the most common complication after autologous fat grafting (AFG) to the breast. Any potential mass can exacerbate patient anxiety and present a diagnostic challenge. We characterized the frequency and management of palpable nodules after AFG to the breast and present a management algorithm.
Methods
Retrospective review of all patients who underwent post-mastectomy AFG by the senior author over a ten year period was performed. Data extracted included demographics, treatment characteristics, fat volume, number of AFG procedures, complication rates, nodule rate, ultrasound and mammogram findings, and biopsy results.
Results
1,158 fat grafting procedures on 775 breasts were identified, of which 67 (8.6%) developed palpable nodules. Four breasts proceeded directly to biopsy, 63 (94.0%) underwent ultrasound, 18 (26.9%) underwent color flow Doppler and 29 (43.3%) underwent mammogram. Based on these results, a management algorithm was developed (Figure 1). Sonographic characterization of nodules included fat necrosis (38.2%), benign lesion (27.6%), oil cysts (17.1%), indeterminate (8.9%) and concern for malignancy (8.1%). Lesions concerning for malignancy were more often irregular (10.0% versus 0-2.9% of benign nodules) and more often larger than 0.8 cm in greatest dimension (80% versus 42.9%-61.8% of benign nodules). Six patients developed a palpable local recurrence.
Conclusions
Palplable nodules are the most common complication of AFG. We present an algorithm based on 1158 AFG procedures. Key discriminating tests include ultrasound and color flow Doppler. This algorithm provides systematic, experiential-based guidance for long term management and surveillance post AFG to the breasts.


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