Autologous fat transfer in reconstructive breast surgery: indications, technique and results

Reconstructive techniques using flaps to preserve the enveloping skin, and even the nipple areolar complex where there is no neoplastic infiltration, have led to vast improvements in the results of reconstructive breast surgery. To further improve the cosmetic outcome, we have applied the technique of autologous fat transfer or lipoinjection, which has proven very successful in cosmetic surgery, to reconstructive breast surgery, and to the treatment of certain cosmetic sequelae of conservative breast treatment. We report our findings.

From September 2001 to September 2005, 74 autologous fat transfers were undertaken in 69 patients, with 5 patients receiving injections in both breasts, to improve the cosmetic appearance through resurfacing and to repair certain sequelae of conservative breast treatment. Pre- and postoperative imaging, including MRI, were undertaken to monitor the viability of the fat grafts and detect any suspicious lesions; no suspect lesions were detected either pre- or postoperatively.

We did not undertake overcorrection, which creates irregularities of surface or contour. Five cases of cytosteatonecrosis were reported among the 74 procedures. The mean follow-up period for the patients was 11.7 months, ranging from 1 month to 3.2 years. The panel judged improvement to be good to very good in 64 breasts (86.5%) and moderate in 10 breasts (13.5%) primarily due to lack of available adipose material for harvesting in these patients.

Autologous fat transfer is now a routine procedure in our clinic due to its simplicity, safety, and reproducibility. It is systematically proposed to all of our patients as the final, perfecting procedure of breast reconstruction, irrespective of the technique used for the initial reconstructive procedure, but also to repair certain conservative treatments.