The Role of Autologous Fat Grafting in Secondary Microsurgical Breast Reconstruction

Background:

Autologous breast reconstruction offers high patient satisfaction, but not all patients are ideal candidates, often due to inadequate volume of donor sites. While autologous fat grafting is used to augment volume and contour abnormalities, its utility in microsurgical breast reconstruction is unclear. We examined our patients to define utility and indications.

Methods:

A retrospective review of all breast reconstruction patients (2007 – 2011) was conducted. Patients were grouped into those requiring fat grafting and those not. Demographics, indications for surgery, history of radiation, BMI, mastectomy weight, rib resection, flap weight, and complications were analyzed in comparison.

Results:

228 patients underwent 374 free flaps. 100 (26.7.%) reconstructed breasts underwent fat grafting (average of 1.12 operative sessions), mostly to the medial and superior poles (average volume 147.8mL). The average ratio of fat to initial flap weight was 0.59 (0.07 – 1.39). Fat grafting patients were more likely to have DIEP and PAP flaps (compared to MS-TRAM) and to have a prophylactic indication (58% (n = 58) versus 42%(n = 117) (p = 0.0087)), rib resection (68% (n = 68) versus 54%(n = 148) (p < 0.0153)), and acute postoperative complications (7% (n = 7) versus 2.1% (n = 8) (p < 0.0480)). Additionally, patients undergoing fat grafting had smaller BMI, mastectomy- and flap-weight.

Conclusions:

Fat grafting is mostly used in patients with rib harvest, DIEP flap reconstructions, and acute postoperative complications. It should be considered a powerful adjunct to improve aesthetic outcomes in volume deficient autologous breast reconstructions.