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Sonographic Assessment on Breast Augmentation after Autologous Fat Graft

Wang, Hongyan M.D.; Jiang, Yuxin M.D.; Meng, Hua M.D.; Yu, Yuan M.D.; Qi, Keming M.D.

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Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 36e-38e
doi: 10.1097/PRS.0b013e3181774732
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Sir:

In 1991, in our hospital, Dr. Keming Qi1 improved the procedure of breast augmentation by repeatedly injecting (one to five times) a low volume of autologous fat (50 to 60 ml per time) into each breast, achieving a satisfactory cosmetic effect with fewer complications. Since 2003, we have used breast ultrasound as an objective method of calculating the absorbance index of grafted fat and to classify the necrotic fat nodules by sonographic changes after each operation.

Thirty-three patients aged 25 to 45 years were injected one to five times in both breasts with a low volume (50 to 60 ml) of autologous fat. The autologous fat was harvested from the abdominal wall or the trochanteric area using the tumescent technique.1 The mixture of fat and anesthetic fluid obtained was placed in a stationary state for 30 minutes, and then the fat was collected from the top layer. The fat was injected into the retromammary layer at the middle point of the inframammary fold or the axillary tail of the breast. Then, the breast was massaged softly until the lump induced by the injection disappeared. The interval between the two operations was more than 1 month. Breast sonographic examination was performed to evaluate the grafted fat tissues. The thickness of the retromammary fat layer before and after each injection was measured at four points (Fig. 1) to calculate the absorbance index. The fat absorbance index was calculated as [1 – (C – A)/(B – A)] × 100 percent, where A, B, and C represent the retromammary fat thickness measured before the operation, the same day after the operation, and 1 month after the operation, respectively. The size and evolution of each necrotic fat nodule were followed up every 3 months.

Fig. 1.
Fig. 1.:
The retromammary fat thickness was measured at the four points as shown by the asterisks, namely, the middle points of the lines between the nipple and the points of the outer edge of the gland at the 3-, 6-, 9-, and 12-o’clock positions. RB, right breast; LB, left breast.

The average fat absorbance index 1 month after each operation was between 34 and 66 percent (Table 1). Although the results are similar to those reported in the literature,2–4 the current data are directly from human patients for the first time. The average thickness of the retromammary fat layer increased from 0.2 cm before the operation to 1.0 cm after the fifth operation. As every patient in the present study had a slim figure with a thin original thickness of the retromammary layer, the cosmetic effect of the breast augmentation was very satisfactory.

Table 1
Table 1:
Average Retromammary Fat Thickness and Average Absorbance Index 1 Month after Each Operation

Fifty-one nodules in 14 patients (42.4 percent) were detected after the fat graft. Forty-nine nodules were found in the retromammary fat layer and two nodules were found in the mammary gland layer, and their connection with the retromammary layer could be found by turning the probe during the examination. Forty-four nodules were nonpalpable and sonographically proved to be completely cystic with regular margins (Fig. 2), could be certainly diagnosed as benign nodules composed mainly of oil released from free lipid without eliciting a surrounding reaction,5 and needed no further treatment other than sonographic follow-up. The other seven nodules (13.7 percent) were palpable and showed a complex or solid appearance on ultrasound images, all of which were followed up every 3 months. No nodule increased in size, and three nodules showed a more cystic component at follow-up. Only one nodule was surgically removed because of patient anxiety, and its pathologic diagnosis was fat necrosis. The solid components of these nodules likely resulted from inflammation or a fibrotic response of the necrotic grafted fat, and there was a trend toward an increase of cystic components, which might be explained by the liquefaction or absorbance of the inflammatory tissue.5

Fig. 2.
Fig. 2.:
A cystic fat nodule shows an anechoic oval area with a well-defined margin and posterior acoustic enhancement on ultrasonography.

In summary, breast augmentation by repeated autologous fat grafting with low-volume injection each time is applicable and satisfactory: the absorbance index is acceptable, most of the necrotic fat nodules are easily diagnosed as benign lesions, and there is no need for further surgery. Also, breast ultrasound is an accurate and simple method of evaluating the absorbance index and following up the temporal changes of the fat nodules after autologous fat injection.

Hongyan Wang, M.D.

Yuxin Jiang, M.D.

Hua Meng, M.D.

Department of Diagnostic Ultrasound

Yuan Yu, M.D.

Keming Qi, M.D.

Department of Plastic Surgery

Peking Union Medical College Hospital

Chinese Academy of Medical Sciences

Beijing, China

ACKNOWLEDGMENT

The authors gratefully acknowledge Dr. Fuhai Li for help with editing this communication.

DISCLOSURE

None of the authors has any financial interests or commercial associations to disclose.

REFERENCES

1. Qi, K., and Chen, J. Breast augmentation of the autologous fat granule injection grafting. Chin. J. Plast. Surg. Burns 13: 222, 1997.
2. Karacaoglu, E., Kizilkaya, E., Cermik, H., et al. The role of recipient sites in fat-graft survival: Experimental study. Ann. Plast. Surg. 55: 62, 2005.
3. Konanas, T. C., Bucky, L. P., Hurley, C., and May, J. W., Jr. The fate of suctioned and surgically removed fat after reimplantation for soft-tissue augmentation: A volumetric and histologic study in the rabbit. Plast. Reconstr. Surg. 93: 763, 1993.
4. Dolsky, R. L., Newman, J., Fetzek, J. R., et al. Liposuction: History, techniques, and complications. Dematol. Chin. 5: 313, 1987.
5. Bilgen, I. G., Usun, E. E., and Memis, A. Fat necrosis of the breast: Clinical, mammographic and sonographic features. Eur. J. Radiol. 39: 92, 2001.

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