Ultrasound Diagnosis and Treatment of Breast Lumps after Breast Augmentation with Autologous Fat Grafting

Abstract

Background:Breast augmentation with autologous fat has been performed in Japan for over 30 years. However, complications include breast lumps and oil cysts. Such breast lumps greatly reduce patient satisfaction, and are currently difficult to diagnose and treat for many cosmetic surgery clinics. This study aimed to elucidate the effectiveness of ultrasound diagnosis and treatment of patients with breast lumps after breast augmentation with autologous fat grafting.Methods:We used diagnostic and therapeutic ultrasound to examine 256 patients with breast lumps between April 2012 and April 2017. We determined the nature, size, and location of the maximal lump. Breast lumps were classified into five types: cystic, complex, solid, calcification, and unclassifiable. The method of treatment (including fine-needle aspiration, VASER liposuction, lumpectomy, and extended lumpectomy) was selected according to the lump type, and the efficacy of treatment was determined by postoperative palpation and ultrasound.Results:A total of 198 patients (198/256, 77%) requested treatment. Cystic lumps (79/256, 31%) were treated by fine-needle aspiration. VASER liposuction was used to treat complex (64/256, 25%) and solid lumps (50/256, 19%). Calcification (58/256, 23%) and unclassifiable lumps (5/256, 2%) were removed via periareolar incision. There were no serious complications. In all cases, the lumps were no longer palpable after treatment, and ultrasound showed that they had either contracted or disappeared.Conclusions:The appropriate treatment for breast lumps after breast augmentation with autologous fat grafting must be selected according to the nature of the lumps. Ultrasound is essential for diagnosing the breast lump type and determining the best treatment.

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“…The role of HRUS in examining the integrity and rotation of a breast implant has been of increasing interest [ 39 , 41 – 48 ]. Moreover, its role has been expanded to manage patients who are suspected of having BIA-ALCL as well as to examine a breast mass [ 49 , 50 ]. In this regard, plastic surgeons are required to make an HRUS-assisted approach to an implant-based augmentation mammaplasty.…”

A Preliminary Exploratory Study of Autologous Fat Transplantation in Breast Augmentation With Different Fat Transplantation Planes

“…No distinct changes were observed in the BIRADS classification in 6 months postoperation. Masaaki et al analyzed the ultrasound results of 256 patients after fat grafting and found that 77% of the breasts had lumps located beneath the mammary glands, 17% beneath the skin, and 6% beneath the pectoralis major muscle (25,26).…”

“…FIGURE 2 | (A)25-year-old female patient from the retropectoral group presented with involutional atrophy of the breasts. She received 300 mL lipoaspirates per breast, with 200 mL into the retropectoral space, 50 mL into the subcutaneous plane and 50 mL into the retromammary space.…”

Recent Developments in Extracellular Matrix Remodeling for Fat Grafting

“…5.7 Oil cysts filled with necrotic material result in persistent inflammation, and calcification continues to develop over time, with these progressive changes persisting ( Mineda et al, 2014 ; Shida et al, 2017 ). Therefore, larger oil sacs should be suctioned under ultrasound guidance, taking care to ensure that all their contents are extracted ( Shida et al, 2017 ). If the suction is incomplete, the lump will persist and the patient will be dissatisfied.…”