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Mammographic Changes after Fat Transfer to the Breast Compared with Changes after Breast Reduction: A Blinded Study

Rubin, J. Peter M.D.; Coon, Devin M.D.; Zuley, Margarita M.D.; Toy, Jonathan M.D.; Asano, Yuko M.D.; Kurita, Masakazu M.D.; Aoi, Noriyuki M.D.; Harii, Kiyonori M.D.; Yoshimura, Kotaro M.D.

Plastic & Reconstructive Surgery: May 2012 - Volume 129 - Issue 5 - p 1029–1038
doi: 10.1097/PRS.0b013e31824a2a8e
Breast: Original Articles
Discussion

Background: One issue in the adoption of autologous fat transfer to the breast is concern over mammographic changes that may obscure cancer detection. The authors compared mammographic changes following fat grafting to the breast with changes seen after breast reduction.

Methods: Twenty-seven women who had normal preoperative mammograms were treated with fat grafting to the breast, including admixing of autologous adipose stem cells with the fat graft, for cosmetic augmentation. Repeated mammograms were performed 12 months after surgery. As a control group, postsurgical mammograms from 23 reduction mammaplasty patients were compared. Eight academic breast imaging radiologists reviewed each mammogram in a blinded fashion. Outcomes analysis accounting for individual radiologist's tendencies was performed using generalized estimating equations.

Results: The average volume of fat injected per patient was 526.5 cc. Fifty mammograms (27 lipotransfer, 23 breast reduction) were assessed. Differences in interpretation among individual radiologists were consistently observed (p < 0.10). Differences in abnormality rates were nonsignificant for oil cysts, benign calcifications, and calcifications warranting biopsy. Scarring (p < 0.001) and masses requiring biopsy (p < 0.001) were more common in the reduction cohort. Breast Imaging Reporting and Data System scores were higher after breast reduction (p < 0.001). Significant differences in the recommended follow-up time were also seen (p < 0.01).

Conclusions: Compared with reduction mammaplasty, a widely accepted procedure, fat grafting to the breast produces fewer radiographic abnormalities with a more favorable Breast Imaging Reporting and Data System score and less aggressive follow-up recommendations by breast radiologists.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Pittsburgh, Pa.; Edmonton, Alberta, Canada; and Yokohama and Tokyo, Japan

From the Division of Plastic Surgery, Department of Surgery, and Department of Radiology, University of Pittsburgh; Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton; Cellport Clinic Yokohama; Department of Plastic Surgery, Teikyo University School of Medicine; Department of Plastic Surgery, Kyorin University School of Medicine; and Department of Plastic Surgery, University of Tokyo School of Medicine.

Received for publication July 6, 2011; accepted October 31, 2011.

Presented at the Northeastern Society of Plastic Surgeons Annual Meeting, in Washington, D.C., October of 2010; the Ohio Valley Society of Plastic Surgeons Annual Meeting, in White Sulfur Springs, West Virginia, June of 2011; and the American Society of Plastic Surgeons Annual Meeting, in Denver, Colorado, October of 2011. First prize winner of the 2010 D. Ralph Millard Investigator Award in the Plastic Surgery Foundation Essay Contest.

Disclosure: The authors have no financial disclosures relating to the contents of this article.

Kotaro Yoshimura, M.D.; Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

J. Peter Rubin, M.D.; Division of Plastic Surgery, University of Pittsburgh Medical Center, 4553 Terrace Street, 6B Scaife Hall, Pittsburgh, Pa, 15261

©2012American Society of Plastic Surgeons