Sonographic evaluation of autologous fat transfer to the biceps and triceps

Autologous fat transfer (AFT) for increased tissue bulk has been reported on since the 1990s, and has increased by 26.6% from 2009 to 2010. Despite this increase, there is relatively little published data. While the described method of AFT to muscle tissue has advantages of being matched to the patient and retaining all the properties of tissue, challenges arise due to the size of muscles, the ability to measure immediate and long term placement and retention, and frequency of aberrant anatomy in order to avoid vasculature and potential complications; reportedly 10% to 27%. We present the results of a study using ultrasound visualization to assist in AFT to the biceps and triceps. Ten male subjects were treated with AFT to the biceps and triceps under intraoperative ultrasonic visualization. Pre- and post-operative circumferential measurements were collected as well as follow-up at weeks six and 12. A mean of 90 cc and 110 cc were injected subfascially into the biceps and triceps, respectively, of 10 study subjects. Post-operative circumferential measurements increased by a mean of 3.0 cm and follow-up measurements were found to have increased by a mean of 3.3 cm over baseline. No compartment syndrome, fat emboli or significant pain were experienced by any subject in this study. Autologous fat transfer to smaller muscle areas such as the bicep and tricep is both feasible and safe with consistent and durable results. The addition of pre-operative ultrasound imaging provides a means to safely avoid critical structures such as vasculature; and intra-operative ultrasound allows the surgeon to directly visualize the relevant anatomy as each injection is performed confirming intramuscular placement.