Autologous Fat Grafting in Reconstructive Breast Surgery: Clinically Relevant Factors Affecting the Graft Take

Volumetric evaluation of autologous fat transfer for total breast reconstruction

BACKGROUND

Reconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although several studies have researched the volumetric aspects of AFT, some outcomes such as volume retention, viability, and possible confounders for graft survival, remain unclear. This study aimed to answer these questions.

METHODS

Post-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months post-operative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis.

RESULTS

A total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Post-operative volumes differed significantly at 12 months in favor of the IBR group (83.8 ml, p < 0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β = 1.107, p = 0.001), comorbidities (β = 28.567, p = 0.002), age (β = -0.514, p = 0.007), and total lipofilling (β = -0.028, p < 0.001).

CONCLUSION

Plastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, and these breast volumes stabilize at 6 months and VECTRA 3D is reliable for breast volume measurement. Approximately a third of the grafted fat was calculated to survive post-operatively and reconstructive surgeons should be aware not to transfer too much fat in one session.

The Landscape of Research on Autologous Fat Grafting for Breast Reconstruction

With increased breast cancer survival rates, the demand for breast reconstruction is rising. Autologous fat grafting (AFG) has gained popularity in breast reconstruction for its soft texture, low immune rejection, and easy accessibility. The hotspot burst analysis identified emerging burst hotspots: survival volume, surgical outcomes, and oncological safety. The Walktrap algorithm highlighted promising areas: "survival, brava" and "safety, cancer." Several studies have demonstrated the oncological safety of AFG for breast reconstruction, but more large-scale, long-term studies are needed. Additionally, AFG faces challenges like unpredictable graft survival and fat stability. Optimizing AFG procedures is crucial to enhance fat survival, reduce complications, and improve patient satisfaction.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/0026 .

Medium- and Long-Term Outcomes of Autologous Fat Grafting to Hands and Feet for Patients With Raynaud Phenomenon

BACKGROUND

Autologous fat grafting (AFG) has emerged as a promising treatment option for Raynaud phenomenon. However, existing studies are limited by short follow-up, and there is little evidence regarding predictive factors for successful outcomes.

METHODS

A retrospective chart review and standardized phone interviews were performed for all patients (n = 17, 65% response rate) treated with AFG to the hands or feet at our institution for primary or secondary Raynaud from 2010 to 2021. Each occurrence of AFG was defined as a separate surgery (n = 23), with an average follow-up of 3.7 years.

RESULTS

At follow-up, patients reported a 31% reduction in cold attack frequency, a 45% reduction in the intensity of individual attacks, a 29% reduction in the duration of attacks, and a 40% improvement in overall Raynaud Condition Score (P < 0.01). Although initial AFG to an extremity significantly improved symptoms, subsequent attempts were not shown to statistically improve outcomes. Digital ulcers were present in 65% of cases, and AFG resulted in ulcer healing in 87% of those cases. Median duration of maximum symptom relief was 1 year postoperatively, with 74% of patients reporting diminishing symptom relief by 4 years postoperatively. Those with a BMI ≥25, with primary Raynaud phenomenon or without preoperative ulcers experienced significantly longer symptom relief (P < 0.05). Average patient satisfaction was 7.7 of 10, and 91% would recommend the procedure to others.

CONCLUSIONS

Autologous fat grafting is an effective, albeit sometimes temporary, treatment for Raynaud and digital ulcers. Certain patients may be more likely to experience lasting symptom relief beyond 1 year.