The Safety of Fat Grafting: An Institutional Retrospective Review

Abstract

Background Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review. Methods An institutional review board–approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ2 test. A P value of 0.05 or less was considered statistically significant for all comparisons. Results A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/− 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/− 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved. Conclusions Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures.

The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis

“…Fat grafting in the breast has been proved to be a well-tolerated procedure [30,31]. Rates of major complications, such as hematoma, infection, and seroma, range from 2 to 3.6%, and are predominantly seen in cases where fat grafting was accompanied by reconstruction or revision.…”

“…Specifically, our review found a lower rate of common surgical complications following fat grafting than the rates mentioned above, potentially because most patients in this review underwent fat grafting as a standalone procedure. It is important to note that our review did not account for any additional procedures performed in conjunction with fat grafting that could contribute to surgical site complications [30]. One study recruited in this review, by Calabrese et al, likely contributes to heterogeneity due to its high rate of revision surgery [21].…”

The Role of Adipose-derived Stem Cell in Breast Reconstruction with Fat Grafting: A Literature Review

“…"ASCs express β-1 integrin (CD29) which participates in angiogenesis and CD44 hyaluronate and osteopontin receptors, which are essential in the development of the extracellular matrix and pathological processes such as neoplasia" [3]. "In vitro and in vivo research show that ASCs are often found lining the outside of microvessels, and they have a stabilizing role by differentiating into pericytes and by expressing common pericyte surface proteins such as the smooth muscle late pericyte marker α-actin (α-SMA), neuronal/glial antigen 2 (NG2) or platelet-derived growth factor receptor β (PDGFRβ)" [8].…”

“…An intraoperative mechanical isolation procedure has been developed to produce tissue-derived stromal vascular fraction (tSVF) with more feasible clinical applications than enzymatic isolated Stromal Vascular Fraction [2]. There are 10.9% complications after fat grafting that have been reported and are considered serious, including hematoma, seroma, fat necrosis, dermatitis, cellulitis, and infection [3]. In this review we summarize the latest research and aim to provide an overview of ADSC angiogenesis in fat grafting, so that in the future research can be found that can avoid complications after fat grafting in breast reconstruction and provide satisfactory breast reconstruction results.…”

In Vitro Characterization of Fat Grafts Processed Using the REVOLVE ENVI System versus Decantation

“…Autologous fat grafting is commonly used for a variety of reconstructive and aesthetic surgery procedures in the face, buttocks, and breasts. [1][2][3][4][5] The American Society of Plastic Surgeons reported that more than 155,000 cosmetic procedures involving fat grafting were performed in 2020. 6 In a clinical setting, one of the major challenges of autologous fat grafting is poor graft retention, ranging from 25% to 90% overall volume loss over time.…”