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.
In 2009, the ASPS (American Society of Plastic Surgery) commissioned a task course regarding current applications and safety autologous fat grafts. A summary of the results helps both plastic surgeons
and patient’s make an informed decision on whether this technique is appropriate.
Here are some in the questions and answers addressed by the task force.
What are the current and potential applications of autologous fat grafting?
Fat grafting may be considered for breast augmentation
and correction of defects associated with medical conditions and previous breast surgeries; however, results are dependent on technique and surgeon expertise. Because of the longevity of the graft is unknown, additional treatments may be necessary to obtain the desired effect. In addition, fluctuations in body weight can affect graft volume over time.
What risks and complications are associated with fat grafting?
Potential complications and risks are described below:
1. Anesthesia-related complications: These complications were uncommon in the review performed by the ASPS task force.
2. Infection. Cases of prolonged inflammation, staph infection, septic shock have been documented with these procedures. Most cases resolve with antibiotic therapy.
3. Bleeding. Cases of seroma or hematoma had been documented with these procedures. No cases, however of unusual or severe bleeding have been presented.
4. Less than expected beneficial outcome. Results from these procedures are typically reported as excellent or good. Overall graft volume loss, via reabsorption or necrosis, is the primary cause of poor results. Initial overcorrection, performed by an experienced surgeon can often compensate for this outcome. Instances of graft hypertrophy or overgrowth have been documented, but are rare. Other complications affecting aesthetic results include formation of calcified and noncalcified masses.
5. Interference with breast cancer detection. No evidence was found that strongly suggests that fat grafting to the breast interferes with the detection of breast cancer. 2 cases of breast cancer were reported after fat grafting to the breast, but there was no delay in detection or treatment. Radiologic studies suggest that imaging technologies (ultrasound, mammography and MRI) can identify the grafted fat tissue, microcalcifications and suspicious lesions; biopsies may be performed if an additional clarification is needed.
6. Embolism. The available literature documents a low case number of embolic complications including fat embolism, stroke, lipoid meningitis, septic shock, or phlebitis.
Overall complications rate associated with fat grafting are not high. Cases of severe complications and death appeared to be extremely rare. Causation of these cases cannot be fully determined.
No compelling evidence was found that would warrant a strong recommendation against autologous fat grafting.
Fat grafting can be considered a safe method of augmentation and correction of defects associated with various medical conditions.