|2009 Annual Meeting Abstracts
Structural Fat Grafting as an Adjunct to Autologous and Implant-Based Breast Reconstruction
Elisabeth K. Beahm, MD1, Robert L. Walton, MD2.
1MD Anderson Cancer Center, Houston, TX, USA, 2Northwestern University, Chicago, IL, USA.
Purpose: Recent empiric clinical reports have promoted autologous fat grafting in both reconstructive and aesthetic applications using small aliquots of fat delivered through multiple injections. In this study, we evaluated the use of autologous fat injections for restoration of contour defects following breast reconstruction.
Methods: A two surgeon, 4.5 year prospective study of fat grafting as an adjunct to autologous and implant-based breast reconstruction was undertaken to evaluate efficacy of the technique. Fat grafting was performed via syringe harvest and centrifugation, with delivery of small aliquots using multiple passes. Defects were not overcorrected. The volume of fat injected was recorded according to site location in each breast. Results were assessed post-operatively at 2-3 weeks, 4 months, 8 months, 12 months, and annually thereafter using physical and photographic documentation. MRI evaluation of several patients pre and post fat grafting provided selective quantification of the results. All patients were followed for a minimum of 6 months and surveyed for satisfaction.
Results: 80 breasts in 61 patients (pts) were included in this study. Mean pt age was 46 years (yrs), (range (R): 31-62 yrs.), Mean follow-up was 1.2 yrs (R: 0.5-4.4 yrs.). Breast reconstruction was 68 % Unilateral (N=42pts) and 32% Bilateral (N=19pts) comprising: Lower abdominal flaps (N= 30 pts/39 breasts, 49%) Implant(s) alone (N=28 pts /37 breasts, 46%); Latissimus Dorsi (LD) with implant (N=3pts/ 4 breasts, 5%). Indications (more than 1 per pt) for grafting included: Loss of volume in flap reconstructions from partial flap loss (N=4), fat necrosis (N=7 pts); contour improvement (N=25 pts), edge contouring in implant or implant-flap reconstructions (N=31 pts), and improvement of depressed port scars (N=12 pts). Mean volume of fat injected per session was 94 cc (R: 54-237). Sectors of the breast treated included Sternal (13%), Superomedial (31%), Superolateral (16%), Inferior (12%), Inferomedial (19%), Inferolateral (7%), Central (2%). Complications included Ecchymosis at recipient site: N= 5, Liponecrotic cysts: N=2, (radiated breasts). Clinical and photographic analysis revealed improvement in contour in the majority of cases but there was clearly loss of volume over time. While not quantified, the volume of injected fat loss/ resorption was estimated to be 30-60% as based on the fat graft volume required for contour restoration in subsequent intervention(s). MRI analysis on selected patients is pending. Additional grafting sessions were required in 67/80 breasts in 52/61 patients to achieve the desired end point. These averaged 1.8 (R: 1-4) sessions per patient. Overall patient satisfaction was 92% Favorable: 1.5% (N=1) Very Dissatisfied; 6.5% (N=4) Somewhat Dissatisfied; 28% Satisfied, (N=17); and 64% (N=39) Very satisfied.
Conclusions: In this initial prospective experience, we have observed sustained, clinical correction of contour deformities following the injection of limited amounts of autologous fat. Use of this technique has proved to be advantageous as an adjunct in autologous as well as implant-based breast reconstructions. Further prospective, volumetrically-controlled studies are necessary to better elucidate the underlying mechanisms of fat graft survival/ growth in this setting, and to verify the longitudinal efficacy of this technique in breast reconstruction.