We wish to comment on the article by Coleman and Saboeiro entitled “Fat Grafting to the Breast Revisited: Safety and Efficacy,” published in the March 2007 issue of the Journal (Plast. Reconstr. Surg. 119: 775, 2007). The authors tried to disprove a theory established in 1987 by the American Society of Plastic and Reconstructive Surgeons, and state in their article that “fat grafting would compromise breast cancer detection and should therefore be prohibited.” Another opinion in the article, that “we should judge fat grafting to the breast with the same caution and enthusiasm that we do with all other breast procedures,” is a sober reflection with which we completely agree.
The photographs and long-term follow-up patient reports are excellent, but the absence of mammograms is a clear weakness of the article. Moreover, the authors state that “missing a cancer is the potential problem after any surgical procedure to the breast.” However, patient selection and careful consideration of indication for surgery are paramount presurgical criteria. Indeed, missing a cancer diagnosis in a young woman who underwent cosmetic fat grafting would be tragic. We agree with the indications for surgery described in the article. However, fat grafting is a versatile procedure that is appropriate in many conditions.
We have treated 15 female patients for effects induced by fat grafting from 2004 to 2006 (average age, 36.4 years). The patients suffered from calcification, multiple cysts, and induration (Fig. 1). In all patients, a tumor-like mass was detected on mammograms, computed tomographic scans, and magnetic resonance imaging scans. In particular, grafted and degenerated tissues were detected as high-iso/low (T1/T2 weighted) on magnetic resonance imaging scans.1 In three cases, yellow liquid accumulation was observed in cysts. In other cases, fibrosis and nonstructual multiple cysts were observed. Unfortunately, the operations in these patients were performed by untrained aesthetic surgeons. Undoubtedly, injection volume per shot, total amount of fat injected, and injection depth must be calculated and performed correctly. Coleman and Saboeiro also noted that aesthetic surgeons performing fat grafting should be competent. Unfortunately, fat grafting is poorly regulated in Japan.
Moreover, psychological damage to patients may be serious. Many patients have undergone fat grafting for cosmetic purposes without careful consideration, and unfavorable results have caused depression. The risk involved in fat grafting must be considered seriously. Although the article by Coleman and Saboeiro is important, we hope it will not be used to justify fat grafting by untrained and mercenary aesthetic surgeons. As the authors mention, patient safety is the most important consideration in plastic surgery.
Rei Ogawa, M.D., Ph.D.
Hiko Hyakusoku, M.D., Ph.D.
Nobuaki Ishii, M.D.
Shimpei Ono, M.D.
Department of Plastic and Reconstructive Surgery
Nippon Medical School Hospital
1. Kawahara, S., Hyakusoku, H., Ogawa, R., Ohkubo, S., Igarashi, H., and Hirakawa, K. Clinical imaging diagnosis of implant materials for breast augmentation. Ann. Plast. Surg.
57: 6, 2006.
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