The Science Behind Fat Grafting and Acellular Dermal Matrices
The increasing popularity of fat grafting is shown in the significant increase in articles being published on the subject over the last 20 years. One study examined the trends in fat grafting through a national survey of the ASPS members (456 respondents of 2584). Sixty-two percent of all respondents reported currently using fat grafting for reconstructive breast surgery. Twenty-eight percent of all respondents reported currently using fat grafting for esthetic breast surgery. Fifty-nine percent have not performed for esthetic surgery and have no plans to perform in future. When asked about potential obstacles to incorporation of fat grafting into clinical practice, 52 % strongly agreed or agreed that poor graft retention rates/or unreliable results are obstacles. Whereas 50 % strongly agreed or agreed that interference with mammography and cancer screening is an obstacle. Forty-nine percent strongly agreed or agreed the lack of evidence concerning the impact of fat grafting to the breast on breast cancer or recurrence is an obstacle. Important questions have also been raised regarding the safety of fat grafting in patients. Recently published studies discussed in this chapter indicate that lipofilling does not appear to increase the risk for recurrence of breast cancer and appears safe for patients who have had breast cancer. In regards to accelerating or causing a primary breast cancer, lipofilling also does not appear to increase risk, even in those patients with the BRCA gene mutation and those without a history of breast cancer. These findings may have broad sweeping implication, not only for breast reconstruction, but also for cosmetic breast augmentation. Anecdotal and preliminary data also examined in this chapter suggest that ADM may contribute to decreased frequency of capsular contracture. However, much of the enthusiasm has been tempered by costs and complications. ADM reconstructions receiving radiation have significantly higher complication rates than nonirradiated ADM reconstructions. Although reports vary for a 4–11 times increase in complications, these are most likely related to the radiation and not the ADM. Interesting scientific findings in animal studies include; no difference in ADM thickness between irradiated and nonirradiated ADM, diminished cellular invasion in irradiated implant reconstructions that had ADM compared to those did not have radiation, ADM decreases radiation related inflammation and delays or diminished pseudoepithelium formation in irradiated implant breast reconstruction. However, many of these changes have been in the short term without evidence of long term impact on the implant capsule. The science indicates that ADM used along with fat grafting holds promise for improving the outcomes and safety of implant-based breast reconstruction, especially in the irradiated breast.
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