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How Fat Grafting Changed the Breast Reconstruction Paradigm: A Narrative Review

Current Surgery Reports (2023)Cite this article

Abstract

Purpose of Review

Since its origin, fat transfer has undergone several improvements, making it a key tool in many fields of plastic surgery, particularly breast reconstruction. It can be used in combination with other techniques to enhance outcomes, or in other cases, it may be the single procedure employed to address partial defects or complete autologous reconstructions. The present review aims to provide a comprehensive overview of the impact fat grafting has had on the field of reconstructive breast surgery.

Recent Findings

Fat grafting provides the benefit of increasing volume while also boosting tissue quality. The volumetric use ranges from improving the aesthetics of a partial defect to the total reconstruction of an expanded breast, as well as complementing a heterologous and autologous reconstruction. It has changed the paradigm of reconstructive surgery improving outcomes and patients’ quality of life following radiotherapy, providing vitality to the tissues, improving the aesthetic results, and consequently, drastically reducing the associated complications.

Summary

Autologous fat grafting has changed the paradigm of breast reconstruction, not only allowing the reconstruction of irradiated patients that were previously considered poor candidate for reconstruction, but also enhancing and optimizing aesthetic outcomes and patient satisfaction while also reducing the risks complications.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Neuber G. Über die Wiederanheilung vollständig vom Körper getrennter, die ganze Fettschicht enthaltender Hautstücke. Zentralblatt Chir. 1893;30:16.

    Google Scholar 

  2. Illouz Y-G. The fat cell “graft”: a new technique to fill depressions. Plast Reconstr Surg. 1986;78(1):122.

    Article  CAS  PubMed  Google Scholar 

  3. Fournier PF. Microlipoextraction et microlipoinjection. Rev Chir Esthet Lang Fr. 1985;10(41).

  4. ••Vizcay M, Saha S, Mohammad A, Pu LLQ, Yoshimura K, Magalon G, Khouri R, Coleman S, Rigotti G, DeFazio S. Current fat grafting practices and preferences: a survey from members of ISPRES. Plast. Reconstr Surg - Glob Open 2023; 11(3), e4849. https://doi.org/10.1097/GOX.0000000000004849. A survey study conducted among plastic surgeons to evaluate and identify current trends of fat grafting practices.

  5. Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg. 1995;19(5):421–5. https://doi.org/10.1007/BF00453875.

    Article  CAS  PubMed  Google Scholar 

  6. Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg. 1997;24(2):347–67.

    Article  CAS  PubMed  Google Scholar 

  7. Zuk PA, Zhu M, Mizuno H, et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng. 2001;7(2):211–28. https://doi.org/10.1089/107632701300062859.

    Article  CAS  PubMed  Google Scholar 

  8. Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13(12):4279–95. https://doi.org/10.1091/mbc.e02-02-0105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gutowski KA, Baker SB, Coleman SR, et al. Current applications and safety of autologous fat grafts: a report of the ASPS Fat Graft Task Force. Plast Reconstr Surg. 2009;124(1):272–80. https://doi.org/10.1097/PRS.0B013E3181A09506.

    Article  CAS  PubMed  Google Scholar 

  10. Cason RW, Shammas RL, Broadwater G, et al. The influence of fat grafting on breast imaging after postmastectomy reconstruction: a matched cohort analysis. Plast Reconstr Surg. 2020;1:1227–36. https://doi.org/10.1097/PRS.0000000000007327.

    Article  CAS  Google Scholar 

  11. Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg. 2013;2(3):143–57. https://doi.org/10.3978/j.issn.2227-684X.2013.08.02.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Orbay H, Hinchcliff KM, Charvet HJ, Sahar DE. Fat graft safety after oncologic surgery: Addressing the contradiction between in vitro and clinical studies. Plast Reconstr Surg. 2018;142(6):1489–99. https://doi.org/10.1097/PRS.0000000000004992.

    Article  CAS  PubMed  Google Scholar 

  13. Tukiama R, Vieira RAC, Facina G, da Cunha Leal P, Zucca-Matthes G. Oncologic Safety of Autologous Fat Grafting after Breast Cancer Surgical Treatment: A Matched Cohort Study. Vol Publish Ah.; 2021. doi:https://doi.org/10.1097/prs.0000000000008037

  14. Sk K, Bs G, Ef C, Lp B. Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities. Plast Reconstr Surg. 2009;124(2):409–18. https://doi.org/10.1097/PRS.0B013E3181AEEADD.

    Article  Google Scholar 

  15. Khouri RK, Rigotti G, Khouri RK Jr, Cardoso E, Marchi A, Rotemberg SC, Baker TJ, Biggs TM. Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience. Plast Reconstr Surg. 2015;135(3):643–58.

    Article  CAS  PubMed  Google Scholar 

  16. Del Vecchio DA. SIEF-simultaneous implant exchange with fat: A new option in revision breast implant surgery. Plast Reconstr Surg. 2012;130(6):1187–96. https://doi.org/10.1097/PRS.0B013E31826D9C3C.

    Article  PubMed  Google Scholar 

  17. Jh K, Aj K, Ka J, Sl B. Mechanisms of radiation-induced skin injury and implications for future clinical trials. Int J Radiat Biol. 2013;89(5):311–8. https://doi.org/10.3109/09553002.2013.765055.

    Article  CAS  Google Scholar 

  18. Jh J. Adipose stem cells and skin repair. Curr Stem Cell Res Ther. 2010;5(2):137–40. https://doi.org/10.2174/157488810791268690.

    Article  Google Scholar 

  19. Shukla L, Morrison WA, Shayan R. Adipose-derived stem cells in radiotherapy injury: a new frontier. Front Surg. 2015;2:1. https://doi.org/10.3389/FSURG.2015.00001.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 2007;119(5):1409–22. https://doi.org/10.1097/01.PRS.0000256047.47909.71.

    Article  CAS  PubMed  Google Scholar 

  21. Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 2012;130(4):513e. https://doi.org/10.1097/PRS.0B013E318262F059.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Komorowska-Timek E, Turfe Z, Davis AT. Outcomes of prosthetic reconstruction of irradiated and nonirradiated breasts with fat grafting. Plast Reconstr Surg. 2017;139(1):1e–9e. https://doi.org/10.1097/PRS.0000000000002916.

    Article  CAS  PubMed  Google Scholar 

  23. Salgarello M, Visconti G, Farallo E. Autologous fat graft in radiated tissue prior to alloplastic reconstruction of the breast: report of two cases. Aesthetic Plast Surg. 2010;34(1):5–10. https://doi.org/10.1007/s00266-009-9367-3.

    Article  PubMed  Google Scholar 

  24. Sarfati I, Ihrai T, Kaufman G, Nos C, Clough KB. Adipose-tissue grafting to the post-mastectomy irradiated chest wall: preparing the ground for implant reconstruction. J Plast Reconstr Aesthetic Surg. 2011;64(9):1161–6. https://doi.org/10.1016/J.BJPS.2011.03.031.

    Article  CAS  Google Scholar 

  25. Salgarello M, Visconti G, Barone-Adesi L. Fat grafting and breast reconstruction with implant: another option for irradiated breast cancer patients. Plast Reconstr Surg. 2012;129(2):317–29. https://doi.org/10.1097/PRS.0B013E31822B6619.

    Article  CAS  PubMed  Google Scholar 

  26. Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM. Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue. Plast Reconstr Surg. 2010;125(1):12–8. https://doi.org/10.1097/PRS.0B013E3181C49458.

    Article  CAS  PubMed  Google Scholar 

  27. Ribuffo D, Atzeni M, Guerra M, Bucher S, Politi C, Deidda M, Atzori F, Dessi M, Madeddu C, Lay G. Treatment of irradiated expanders: protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy. Aesth Plast Surg. 2013;37(1146–52):1152. https://doi.org/10.1007/S00266-013-0221-2.

    Article  Google Scholar 

  28. Vaia N, Lo Torto F, Marcasciano M, Casella D, Cacace C, De Masi C, Ricci F, Ribuffo D. From the “Fat Capsule” to the “Fat Belt”: limiting protective lipofilling on irradiated expanders for breast reconstruction to selective key areas. Aesth Plast Surg. 2018;42:986–94. https://doi.org/10.1007/S00266-018-1120-3.

    Article  Google Scholar 

  29. Kenny EM, Egro FM, Ejaz A, Coleman SR, Greenberger JS, Rubin JP. Fat grafting in radiation-induced soft-tissue injury: a narrative review of the clinical evidence and implications for future studies. Plast Reconstr Surg. 2021. https://doi.org/10.1097/PRS.0000000000007705.

    Article  PubMed  Google Scholar 

  30. Khouri RK, Smit JM, Cardoso E, et al. Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction? Plast Reconstr Surg. 2013;132(5):1280–90. https://doi.org/10.1097/PRS.0B013E3182A4C3A9.

    Article  CAS  PubMed  Google Scholar 

  31. Laporta R, Longo B, Sorotos M, Pagnoni M, Santanelli di Pompeo F. Breast reconstruction with delayed fat-graft-augmented diep flap in patients with insufficient donor-site volume. Aesth Plast Surg. 2015;39:339–49. https://doi.org/10.1007/S00266-015-0475-Y.

    Article  Google Scholar 

  32. •Economides JM, Song DH. Latissimus Dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction. Plast Reconstr Surg Glob Open. 2018. https://doi.org/10.1097/GOX.0000000000001656. A study that analyzed retrospectively lipotransfer prior to disorigination of the LD muscle, concludeding minimal trauma to the flap and increases the efficiency of fat grafting.

  33. Zhu L, Mohan AT, Vijayasekaran A, Hou C, Sur YJ, Morsy M, Saint-Cyr M. Maximizing the volume of latissimus dorsi flap in autologous breast reconstruction with simultaneous multisite fat grafting. Aesth Surg J. 2016;36(2):169–78. https://doi.org/10.1093/ASJ/SJV173.

    Article  Google Scholar 

  34. Niddam J, Vidal L, Hersant B, Meningaud JP. Primary fat grafting to the pectoralis muscle during Latissimus Dorsi breast reconstruction. Plast Reconstr surgery Glob open. 2016;4(11):e1059. https://doi.org/10.1097/GOX.0000000000001059.

    Article  Google Scholar 

  35. Flaherty F, Chouhy E, Vizcay M, Chang EI. Revisiting the back as an option in breast reconstruction: from basic to cutting edge. Ann Breast Surg. 2020;(Novel Innovations and Advancements in Breast Reconstruction).

  36. Khouri RK, Khouri RK. Current clinical applications of fat grafting. Plast Reconstr Surg. 2017;140(3):466E-486E. https://doi.org/10.1097/PRS.0000000000003648.

    Article  CAS  PubMed  Google Scholar 

  37. Garza RM, Paik KJ, Chung MT, et al. Studies in fat grafting: Part III. Fat grafting irradiated tissue—improved skin quality and decreased fat graft retention. Plast Reconstr Surg. 2014;134(2):249–57. https://doi.org/10.1097/PRS.0000000000000326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Panettiere P, Marchetti L, Accorsi D. The serial free fat transfer in irradiated prosthetic breast reconstructions. Aesth Plast Surg. 2009;33:695–700. https://doi.org/10.1007/S00266-009-9366-4.

    Article  Google Scholar 

  39. Panettiere P, Accorsi D, Marchetti L. The role of free fat graft in breast reconstruction after radiotherapy. Curr Concepts Plast Surg. 2012. https://doi.org/10.5772/27254.

    Article  Google Scholar 

  40. Papadopoulos S, Vidovic G, Neid M, Abdallah A. Using fat grafting to treat breast implant capsular contracture. Plast Reconstr Surg Glob Open. 2018;6(11):e1969. https://doi.org/10.1097/GOX.0000000000001969.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Calabrese S, Zingaretti N, De Francesco F, et al. Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts. Eur J Plast Surg 2019 433. 2019;43(3):257–268. doi:https://doi.org/10.1007/S00238-019-01577-Z

  42. Cordeiro PG, Albornoz CR, McCormick B, Hudis CA, Hu Q, Heerdt A, Matros E. What is the optimum timing of post-mastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg. 2015;135(6):1509–17. https://doi.org/10.1097/PRS.0000000000001278.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hoang HLT, Gruszynski GC, Barr M, Da LAL. Abstract: fat grafting prior to tissue expander exchange can optimize results in implant- based reconstruction in irradiated breast. Plast Reconstr Surg Glob Open. 2017;5(9 Suppl):76–7. https://doi.org/10.1097/01.GOX.0000526273.89171.85.

    Article  PubMed Central  Google Scholar 

  44. Flaherty F, Vizcay M, Chang EI. Implant Based Breast Reconstruction Cutting Edge and Controversiese. Curr Surg Reports. 2020.

  45. Mh A, Sa D. Immediate large-volume grafting of autologous fat to the breast following implant removal. Aesthetic Surg J. 2015;35(7):819–29. https://doi.org/10.1093/ASJ/SJV073.

    Article  Google Scholar 

  46. Del Vecchio DA, Bucky LP. Breast augmentation using preexpansion and autologous fat transplantation: a clinical radiographic study. Plast Reconstr Surg. 2011;127(6):2441–50. https://doi.org/10.1097/PRS.0B013E3182050A64.

    Article  PubMed  Google Scholar 

  47. Blugerman G, Schavelzon D, Wexler G, Lotocki M, Schavelzon V, Blugerman G. Pneumodissection: enhancement of the receptor area before fat grafting. Body Contouring Sculpt. 2016. https://doi.org/10.5772/64838.

    Article  Google Scholar 

  48. Irigo M, Saldias A, Colque Peca ML, et al. Neumodisección con CO2 para lipotransferencia en reconstrucción mamaria. Rev Argent Mastología. 2018:89–100. https://www.revistasamas.org.ar/revistas/2018_v36_n133/10.pdf. Accessed 2 Sept 2021

  49. Abboud MH, El Hajj H, Kapila AK, Bogaert S, Abboud NM. Scarless composite breast reconstruction utilizing an advancement skin flap, loops, and lipofilling. Aesthetic Surg J. 2022;42(1):38–53. https://doi.org/10.1093/asj/sjab049.

    Article  Google Scholar 

  50. •Caviggioli F, Maione L, Klinger F, Lisa A, Klinger M. Autologous fat grafting reduces pain in irradiated breast: a review of our experience. Stem Cells Int. 2016; 2016.https://doi.org/10.1155/2016/2527349. In a 8-year experience restrospective this study confirms fat grafting effectiveness in decreasing neuropathic pain.

  51. Caviggioli F, Maione L, Forcellini D, Klinger F, Klinger M. Autologous fat graft in postmastectomy pain syndrome. Plast Reconstr Surg. 2011;128(2):349–52. https://doi.org/10.1097/PRS.0B013E31821E70E7.

    Article  CAS  PubMed  Google Scholar 

  52. Maione L, Vinci V, Caviggioli F, Klinger F, Banzatti B, Catania B, Lisa A, Klinger M. Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy. Aesth Plast Surg. 2014;38:528–32. https://doi.org/10.1007/S00266-014-0311-9.

    Article  Google Scholar 

  53. ••Maximiliano J, Munhoz AM, Pedron M, et al. Hybrid breast augmentation: A reliable formula for preoperative assessment of fat graft volume based on implant volume and projection. Aesthetic Surg J. 2020;40(8):NP438-NP452. https://doi.org/10.1093/asj/sjaa017. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for breast augmentation with fat grafting.

  54. Munhoz AM, Maximiliano J, Neto ADAM, et al. Zones for fat grafting in hybrid breast augmentation: standardization for planning of fat grafting based on breast cleavage units. Plast Reconstr Surg. 2022;150(4):782–95. https://doi.org/10.1097/PRS.0000000000009605.

    Article  CAS  PubMed  Google Scholar 

  55. Thomas S, Chen S, Sbitany H, et al. Autologous fat grafting as a novel antiestrogen vehicle for the treatment of breast cancer. Plast Reconstr Surg. 2017;140(3):537–44. https://doi.org/10.1097/PRS.0000000000003579.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic Surgery, Otamendi Medical Center, Buenos Aires, Argentina

    Federico Flaherty, Eugenio Chouhy & Diego Pugliese

  2. University Department of Hand Surgery & Rehabilitation, IRCCS MultiMedica Group, Milan, Italy

    Macarena Vizcay

  3. Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Edward I. Chang

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  1. Federico Flaherty
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  3. Eugenio Chouhy
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  4. Diego Pugliese
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  5. Edward I. Chang
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Contributions

(I) Conception and design: FF and MV. (II) Administrative support: MV. (III) Provision of study materials or patients: FF, EC. (IV) Collection and assembly of data: All authors. (V) Data analysis and interpretation: All authors. (VI) Manuscript writing: All authors. (VII) Final approval of manuscript: All authors.

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Correspondence to Federico Flaherty.

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None of the others authors of this manuscript have any relevant financial disclosures or conflicts of interest to report. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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Ethical committees, Internal Review Boards and guidelines followed must be named. When applicable, additional headings with statements on consent to participate and consent to publish are also required). The Section Editors for the topical collection Plastic Surgery are Edward Chang and Matthew Hanasono. Please note that Dr. Chang was not involved in the editorial process of this article as he is a co-author.

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Flaherty, F., Vizcay, M., Chouhy, E. et al. How Fat Grafting Changed the Breast Reconstruction Paradigm: A Narrative Review. Curr Surg Rep (2023). https://doi.org/10.1007/s40137-023-00360-1

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Keywords

  • Fat grafting
  • Breast reconstruction
  • Irradiated breast
  • Fat grafting flaps
  • Lift
  • Lipofilling