Article
The Role of Autologous Fat Grafting in Secondary Microsurgical Breast Reconstruction
Search Medline for
Authors
-
P. Niclas Broer
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika; Klinikum Bogenhausen, Abteilung Plastische Chirurgie, Muenchen, Deutschland
-
Katie Weichman
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
-
Neil Tanna
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
-
Christina Ahn
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
-
Jamie Levine
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
-
Jamie Levine
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
-
Robert Allen
- New York Univevrsity, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
| Published: | September 10, 2013 |
|---|
Outline
Text
Purpose: To evaluate indications and utility of fat grafting to the breast in cases of autologous reconstruction.
Background: Autologous breast reconstruction offers higher rates of patient satisfaction, but not all patients are ideal candidates, often due to inadequate volume of donor sites. While autologous fat grafting is frequently used to augment volume and contour abnormalities in implant-based breast reconstruction, its clear utility in microsurgical breast reconstruction has yet to be defined. Here, we examined patients undergoing autologous microsurgical breast reconstruction with and without the adjunct of autologous fat grafting to clearly define utility and indications for use.
Methods: A retrospective review of all patients undergoing autologous breast reconstruction with microvascular free flaps at a single institution between November 2007 and October 2011 was conducted. Patients were divided into two groups: those requiring postoperative fat grafting and those not requiring fat grafting. Patient demographics, indications for surgery, history of radiation therapy, patient BMI, mastectomy specimen weight, need for rib resection, flap weight, and complications were analyzed in comparison.
Results: 228 patients underwent 374 microvascular free flaps for breast reconstruction. One-hundred (26.7.%) reconstructed breasts underwent postoperative fat grafting, with an average of 1.12 operative sessions.. Fat was most commonly injected in the medial and superior medial poles of the breast and the average volume injected was 147.8mL per breast (22-564mL). The average ratio of fat injected to initial flap weight was 0.59 (0.07-1.39). Patients undergoing fat grafting were more likely to have had DIEP and PAP flaps as compared to MS TRAM. Patients additionally were more likely to have a prophylactic indication 58% (n=58) versus 42%(n=117) (p=0.0087), rib resection 68% (n=68) versus 54% (n=148) p< 0.0153), and acute postoperative complications requiring operative intervention 7% (n=7) versus 2.1% (n=8) p.
Conclusions: Fat grafting is most commonly used in those breasts with rib harvest, DIEP flap reconstructions, and those with acute postoperative complications. It should be considered a powerful adjunct to improve aesthetic outcomes in volume deficient autologous breast reconstructions and additionally optimize contour in volume-adequate breast reconstructions.
Clinical Question: Therapeutic
Level of Evidence: Level III
