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    Kenneth Bermudez, MD, is a board-certified plastic surgeon with more than 20 years of experience. He is committed to helping his San Francisco cosmetic and reconstructive surgery patients achieve — and often exceed — their cosmetic goals.

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Fat Grafting 101

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.