Fat Grafting as an Adjunct Procedure in Breast Reconstruction

Introduction

Autologous fat grafting to the breast is a widely used and accepted adjunct in breast reconstruction today. The technique involves harvest of fat from patient-specific donor sites, fat processing, and subsequent transfer in order to improve depressions and step-offs, which may exist at the junction of the reconstructed breast and chest wall, or following lumpectomy.

First introduced in 1895 by Czerny, fat grafting was utilized when an excised lipoma was transferred to the breast to reconstruct a breast defect. In the early 20 ^th century, fat grafting gained momentum, however the practice of fat grafting did not become popular until the 1980s. In 1987, however, the American Society of Plastic Surgeons (ASPS) banned autologous fat grafting of breasts over concern for future cancer surveillance in the setting of fat necrosis. In 2007, the ASPS established a task force to re-evaluate the potential hazards of fat grafting, and concluded that radiographic technology could distinguish grafted fat from potentially dangerous lesions. Therefore, the ASPS Fat Graft Task Force lifted the ban on fat grafting in 2009 when it determined from a limited number of studies that there appeared to be no interference with breast cancer detection.

Numerous recent studies have demonstrated the regenerative capabilities of transferred fat, including improved angiogenesis, dermal thickness and elasticity, and radiation-induced fibrotic changes. For this reason, fat grafting has become a useful adjunct and workhorse in lumpectomy defects as well as autologous and implant-based breast reconstruction, particularly in radiated fields.

Successful fat grafting requires close attention to the recipient site compliance and capacity, as well as thorough fat harvesting, processing, and delivery technique. Here, we discuss the current indications for autologous fat grafting as an adjunct in breast reconstruction and review pertinent aspects of the preoperative patient evaluation. We describe operative techniques including donor-site selection, fat harvesting and processing. We conclude with several case examples and a review of postoperative complications and their management.

Indications and Contraindications

Autologous fat grafting is indicated for the correction of contour deformities and step-offs following autologous or implant-based post-mastectomy breast reconstruction, which often occur at the periphery of the breast reconstruction. Transferred fat may also be utilized to improve the contour of lumpectomy defects. However, established and safe indications for autologous fat grafting vary by breast reconstruction modality.