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A Classification of Clinical Fat Grafting: Different Problems, Different Solutions

Del Vecchio, Daniel M.D., M.B.A.; Rohrich, Rod J. M.D.

Plastic & Reconstructive Surgery: September 2012 - Volume 130 - Issue 3 - p 511–522
doi: 10.1097/PRS.0b013e31825dbf8a
Breast: Special Topic
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Background: Fat grafting has reemerged from a highly variable procedure to a technique with vast reconstructive and cosmetic potential. Largely because of a more disciplined and scientific approach to fat grafting as a transplantation event, early adopters of fat transplantation have begun to approach fat grafting as a process, using sound surgical transplantation principles: recipient preparation, controlled donor harvest, time-efficient transplantation, and proper postoperative care. Despite these principles, different fat grafting techniques yield impressive clinical outcomes.

Methods: The essential variables of four types of fat grafting cases were identified and compared: harvesting, methods of cell processing, methods of transplantation, and management of the recipient site.

Results: Each case differed for most of the variables analyzed. The two clinical drivers that most impacted these differences were the volume demands of the recipient site and whether the recipient site was healthy tissue or pathologic tissue. After these two drivers, a matrix classification of small-volume versus large-volume and regenerative versus nonregenerative cases yields four distinct categories.

Conclusions: Not all fat grafting is the same. Fat grafting, once thought to be a simple technique with variable results, is a much more complex procedure with at least four definable subtypes. By defining the essential differences in the recipient site, the key driver in fat transplantation, the proper selection of technique can be best chosen. In fat transplantation, different problems require different solutions.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Boston, Mass.; and Dallas, Texas

From Back Bay Plastic Surgery and the University of Texas Southwestern Medical Center.

Received for publication December 29, 2012; accepted April 3, 2012.

Disclosure: The authors have no financial relationships to declare that would create a conflict of interest.

Daniel Del Vecchio, M.D., M.B.A.; Back Bay Plastic Surgery, 38 Newbury Street, Boston, Mass. 02116, dandelvecchio@aol.com

©2012American Society of Plastic Surgeons