We congratulate the authors of the article entitled “Fat Grafting to the Breast Revisited: Safety and Efficacy” (Plast. Reconstr. Surg. 119: 775, 2007),1 which we hope will help to refute the 1987 position paper by the American Society of Plastic and Reconstructive Surgeons.2 Although the number of cases presented is small, the results are very impressive. The authors’ experience is mirrored by probably several thousand procedures performed in Europe and Asia as well. In our unit, fat grafting represents a first choice when augmentation or contour refinements of reconstructed breasts are required and as part of a reconstructive plan for patients who want to avoid breast implants. There are, however, several important safety aspects that cannot be emphasized enough. Preoperative and postoperative breast imaging is vital to document any existing or emerging abnormalities within a native, reconstructed, or conserved breast. In the Canniesburn Plastic Unit, fat grafting is mainly performed as an adjunct to autologous breast reconstruction with latissimus dorsi flaps or abdominal free tissue transfers, and in our experience, preoperative and postoperative mammography is the most feasible, cost-effective, and sensitive method of imaging, followed by tissue diagnosis of any abnormalities. Although it is potentially difficult to achieve, due to poor patient compliance, this practice should also be used in cases of fat transfer to the healthy breast for cosmetic or asymmetry purposes. The authors present a relatively high rate of post–fat transfer calcifications and fat necrosis; this may be related in part to the large amount of fat transferred in one session. In our patients, we transferred, on average, 197 cc of fat per breast and session. This can be achieved within approximately 90 minutes of operating time, and the incidences of calcification and fat necrosis are much lower.
From October of 2005 to March of 2007 in the Canniesburn Plastic Unit, 42 women (average age, 48 years) underwent contour deformity correction or augmentation of reconstructed breasts by adipose graft injection using the Coleman technique. Upper pole filling and scar release were the main goals of treatment. The average follow-up was 7 months; only one patient (2.4 percent) had partial liponecrosis. As a consequence of the limited initial transfer, we have a higher proportion of two-stage procedures. Nine women had additional fat transplants and four patients were actually in list for further lipofilling (31 percent).
Stefano Cotrufo, M.D.
Anirban Mandal, F.R.C.S.
Eva M. Weiler Mithoff, F.R.C.S.
Plastic and Reconstructive Unit
Policlinic Gaetano Martino
1. Coleman, S. R., and Saboeiro, A. P. Fat grafting to the breast revisited: Safety and efficacy. Plast. Reconstr. Surg.
119: 775, 2007.
2. ASPRS Ad-Hoc Committee on New Procedures. Report on autologous fat transplantation. September 30, 1987.
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