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Fat Grafting and the Palpable Breast Mass in Implant Based Breast Reconstruction

Incidence and Implications

Knackstedt, Rebecca W. MD, PhD1; Gatherwright, James MD2; Ataya, Dana MD3; Duraes, Eliana MD, PhD1; Schwarz, Graham S. MD1

Plastic and Reconstructive Surgery: May 6, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005790
Original Article: PDF Only

Background: Fat grafting is a powerful and increasingly utilized technique in breast reconstruction. However, fat necrosis can lead to palpable post-operative changes that can induce anxiety and lead to unplanned diagnostic studies. Our aim in this study was to evaluate the incidence, type and timing of these unanticipated studies, the specialty of the ordering provider and the factors that trigger the ordering process.

Methods: A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant based breast cancer reconstruction and had at least one-year follow-up after fat grafting.

Results: From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. 44 (26.5%) women underwent at least one imaging procedure. 13 (7.8%) women underwent 17 biopsies. For a palpable mass, the first imaging most commonly ordered was ultrasound, followed by mammogram/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammogram, ultrasound and biopsy were 4.2%, 12.7% and 5.4%, respectively. 7 (4.2%) patients had distant metastasis. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years.

Conclusion: Fat grafting sequelae may lead to early unplanned invasive and non-invasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers as well as patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions.

1. Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio

2. Division of Plastic Surgery, MetroHealth, Cleveland, Ohio

3. Department of Radiology, Cleveland Clinic, Cleveland, Ohio

The authors have no financial disclosure to report.

Corresponding Author: Graham S. Schwarz, MD, Cleveland Clinic , Department of Plastic Surgery, 9500 Euclid Ave , Mail Code A 60, Cleveland, OH 44195

©2019American Society of Plastic Surgeons