We read with great interest the recent clinical report by Dr. Serra-Renom and colleagues regarding fat grafting in postmastectomy patients with expanders and prosthesis following radiotherapy.1 We would like to congratulate the authors on their impressive clinical results. However, we would like to highlight potential safety issues.
The authors combined serial fat grafting in the irradiated breast skin and the muscle with subsequent expander and later prosthesis for secondary breast reconstruction. Follow-up was 12 months. Clinically, no complications were reported. Given the introduction of the BREAST-Q, one might consider using this valuable tool in this patient cohort.2 Recently, the BREAST-Q has been applied to compare patient satisfaction and health-related quality of life following breast reconstruction with either saline or silicone gel implants.3
The authors achieved impressive clinical results, with high patient satisfaction. However, autologous fat injection into the breast is not necessarily a simple and straightforward procedure, which might be delineated by this report. Recently, the Journal has presented a case series of 12 patients suffering complications following autologous fat transplantation in Japan.4 Four of 12 patients had abnormalities on breast cancer screening. The authors concluded that patients should be thoroughly informed about a potential risk of calcification and should be followed over a long term with imaging analysis. Magnetic resonance imaging is one valid option in this regard.5 Notably, volumetry of the autologous fat tissue transferred is achievable using magnetic resonance imaging–based algorithms.6
Thus, unless prospective higher level evidence-based recommendations are applicable, one might consider serial magnetic resonance imaging following fat injection in the breast for volumetry to assess efficacy and longevity of the autologous fat transplantation and to improve and enhance patient safety in terms of potential adverse effects. However, the costs of such serial magnetic resonance imaging have to be taken into account in this regard.
Karsten Knobloch, M.D., Ph.D.
Christian Herold, M.D.
Hans-Oliver Rennekampff, M.D.
Peter M. Vogt, M.D., Ph.D.
Plastic, Hand, and Reconstructive Surgery
Hannover Medical School
1. Serra-Renom JM, Del Olmo JM, Serra-Mestre JM. Fat grafting in post mastectomy breast reconstruction with expanders and prosthesis in patients who have received radiotherapy: Formation of new subcutaneous tissue. Plast Reconstr Surg.
2. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg.
3. Macadam SA, Ho AL, Cook EF Jr, Lennox PA, Pusic AL. Patient satisfaction and health-related quality of life following breast reconstruction: A comparison of patient-reported outcomes amongst saline and silicone implant recipients. Plast Reconstr Surg.
4. Hyakusoku H, Ogawa R, Ono S, Ishii N, Hirakawa K. Complications after autologous fat injection to the breast. Plast Reconstr Surg.
2009;123:360–370; discussion 371–372.
5. Mu DL, Luan J, Mu L, Xin MQ. Breast augmentation by autologous fat injection grafting: Management and clinical analysis of complications. Ann Plast Surg.
6. Yoshimura K, Asano Y, Aoi N, et al. Progenitor-enriched adipose tissue transplantation as rescue for breast implant complications. Breast J.
Epub ahead of print November 12, 2009.
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