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Complication Rates Of Fat Grafting Associated With Various Modalities Of Breast Reconstruction
Zaahir Turfe, B.S.1, Alan Davis, PhD2, Ewa Komorowska-Timek, M.D.3.
1Michigan State University College of Human Medicine, Grand Rapids, MI, USA, 2Grand Rapids Medical Education Partners, Grand Rapids, MI, USA, 3Michigan State University College of Human Medicine, Advanced Plastic Surgery, Grand Rapids, MI, USA.
Fat grafting is gaining popularity as a solo or adjunct treatment modality in breast reconstruction. Complication rates of this procedure, however, have not been clearly elucidated. The current study reviews a large single surgeon cohort of fat grafting procedures to define complication rates of this technique in various reconstructive scenarios.
All breast fat grafting procedures conducted by a single surgeon from 2010 to 2013 were included in the study. The patients’ demographics, comorbidities, indications for fat grafting, technique of fat preparation, volume of transferred fat, and complications resulting from each procedure were noted. Indications for fat grafting were defined as follows: 1. contour deficiency over prosthetic or autologous flap 2. Breast reconstruction after mastectomy and/or implant failure 3. Post lumpectomy 4. Attempt to alter the skin after radiation 5. Congenital or cosmetic. Complications included infection, fat necrosis, cyst formation, wound dehiscence, sterile collection of necrotic fat, and abscess formation.
A total of 123 patients with average age of 50.8 ± 10.2 years underwent 173 fat grafting procedures. The average BMI of our patients was 26.5 ± 6.0. Seventeen of 123 (13.8%) were smokers, 5/123 (4%) were diabetic, and 17/123 (13.8%) were hypertensive. The indications for fat grafting were distributed as follows: countour deficiency over a prosthetic or autologous flap in 141/173 (81.5%) of cases, breast reconstruction after mastectomy and/or implant failure in 7/173 (4%) of cases, lumpectomy defect in 8/173 (4.6%) of cases, attempt to alter the skin after radiation in 9/173 (5.2%) of cases, and correction of congenital or cosmetic defects in 3/173 (1.7%) of cases. Five of 173 (2.9%) procedures were conducted due to a combination of 2 of the aforementioned indications. The mean follow up was 535 ± 34 days. Overall, complications occurred following 55/173 (32.3%) of the procedures. Majority of procedures were associated with prosthetic reconstruction (118/173, 68%), and there was no significant difference in complication rates of fat grafting as an adjunct to either prosthetic or autologous reconstruction (37/118 [31.4%] vs. 18/55 [32.7%], p=0.86). Furthermore, 68/173 (39%) procedures were conducted in association with radiation therapy, but there was no significant difference in complication rates in radiated vs non-radiated breasts (24/68 [35.3%] vs 31/102 [30.4%] p=0.5, respectively). The technique used to graft the fat (centrifugation vs straining) and the volume of transferred fat did not yield any statistically significant difference in outcomes irrespective of radiation history.
Fat grafting is an important modality utilized in cosmetic and reconstructive that offers great versatility in multiple clinical scenarios. Our data suggests that fat grafting can be performed in the setting of prosthetic breast reconstruction or radiation therapy without increasing post-procedural morbidity.
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