How does the harvest and preparation technique of affect outcomes?
Harvest technique. Exposure to air a mechanical damage should be minimized during harvest. It is suggested that tissue harvest be performed using a 3– 4 mm blunt cannula or similar needle while utilizing minimal amounts of suction during extraction.
Harvest sites. The primary concerns to be addressed during choice of harvest sites are adequate tissue volume and patient/physician preference. There is no compelling evidence regarding harvest site and efficacy of fat grafting.
Graft preparation. Avoid contamination maximize tissue viability by minimizing exposure to air and mechanical damage.
Injection technique. Graft injection should be performed using 2–2.5 mm blunt-tipped infusion cannula or similar blunt needle and with injection occurring in multiple passes, resulting in a small fat deposited with each pass.
Injection site. Patient specific. There is no evidence to indicate whether or not injection site significantly effects graft viability.
Use of epinephrine and lidocaine at the donor site. The use of either epinephrine or lidocaine has not been shown to affect graft viability.
What risk factors need to be considered for patient selection at this level of invasiveness?
No evidence was found and specifically addressed patient selection. Therefore, the recommendation was developed by consensus of the task force and is considered expert opinion. When determining whether or not a patient is an appropriate candidate for autologous fat grafting to the breasts, physician should exercise caution when considering high risk patients (those with risk factors for breast cancer: BRCA–1, BRCA–2, and/or personal or familial history of breast cancer with primary relatives).
What advancements in research impacted current or future methods of autologous fat grafting?
Current studies consist of both in vitro an animal studies describing manipulations to improve viability of the graft. No randomized control trials were identified. Further research needs to be done.
Fat grafts may be considered for the use of breast that other sites, the specific techniques for grafting are not standardized. The results, therefore, may vary depending on the surgeon’s technique and experience with the procedure. Although there are a few data to provide evidence for long-term safety and efficacy of fat grafting, the reported complications suggests that there are associated risks.
Regarding fat grafting to the breast, there are no reports suggesting an increased risk of malignancy associated with fat grafting. Limited data available suggests the fact grafting not interfere with radiologic imaging and detecting breast cancer.