A Randomized, Prospective Comparison Of Processing Techniques In Autologous Fat Grafting For Contouring Breast Reconstruction
Summer E. Hanson, MD, PhD, Patrick B. Garvey, MD, Edward I. Chang, MD, Gregory P. Reece, MD, Donald P. Baumann, MD, Jun Liu, PhD, Charles E. Butler, MD.
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Purpose: Autologous fat grafting (AFG) is a useful tool in contouring breast reconstruction. We have previously demonstrated a difference in the rate of processing adipose grafts. The purpose of this study was to compare clinical outcomes in grafting for three commonly used methods for graft preparation. Methods: We conducted a prospective, randomized comparison of methods to prepare adipose grafts: a passive washing-filtration system (PureGraft TM , system-PF), an active washing-filtration system (Revolve TM , system-AF) or centrifugation (Coleman technique, C). Postoperative complications, fat necrosis and revision rates were compared. Results: Forty-six participants were enrolled (15 PF, 15 AF and 16 C). Mean age was 54 years and mean BMI was 28.6 kg/m2. The average follow-up was 16.9 ± 4 months. The majority had skin-sparing mastectomy (87%). Of 66 breasts, the overall complication rate was 12.1%. The rate of fat necrosis was no different among the groups (AF=15% vs PF=14.7% vs C=8%; p=0.72). Fat necrosis was more common with previous breast conservation therapy (60%, p=0.01). There was no difference in residual contour irregularity (AF=40% vs PF=38% vs C=36%, p=0.96). Likelihood of additional grafting was higher in the centrifugation group though this did not achieve significance (AF=20% vs PF=14.3% vs C=32%, p=0.34). Conclusions: In the first prospective, randomized study to compare clinical outcomes of three methods of AFG preparation, we demonstrate no significant difference in complications or rates of additional grafting. There was significantly higher risk of fat necrosis in patients with prior breast conservation therapy regardless of processing technique.
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