Diagnosis and management of fat necrosis after autologous fat transplantation of breast_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Miao ,  LI Facheng

The 18th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100144, P.R.China;

Corresponding author：

LI Facheng, Email: drlfc@sina.com

Keywords：

Autologous fat transplantation; fat necrosis; complication; diagnosis; management

DOI：

10.7507/1002-1892.202102052

Video：

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Objective To review the diagnosis and management of fat necrosis after autologous fat transplantation of breast.Methods Based on the latest related literature, the pathology, clinical and radiographic examinations, influence factors, as well as the management of fat necrosis after autologous fat transplantation for breast augmentation and reconstruction were summarized.Results Fat necrosis after breast autologous fat transplantation is histologically manifested as hyaline degeneration, fibrosis, and calcification. The diagnosis of fat necrosis includes clinical examination, imaging examination (ultrasound, mammography, and MRI), and biopsy. The occurrence of fat necrosis is closely related to patient’s own reason and fat transplantation technology. Optimizing the process of fat acquisition, purification, and transplantation can reduce the occurrence of fat necrosis. Intervention or not after fat necrosis depends on the nature of the nodules. According to the nature of the the nodules, various methods such as simple aspiration, vibration amplification of sound energy at resonance liposuction, or direct excision can be selected.Conclusion Fat necrosis after autologous fat transplantation of breast are difficult to control. How to process fat to minimize the injury and maximize the activity of grafted fat needs further researches.

Citation： DONG Miao, LI Facheng. Diagnosis and management of fat necrosis after autologous fat transplantation of breast. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 918-922. doi: 10.7507/1002-1892.202102052 Copy

1.	Groen JW, Negenborn VL, Twisk DJWR, et al. Autologous fat grafting in onco-plastic breast reconstruction: A systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction. J Plast Reconstr Aesthet Surg, 2016, 69(6): 742-764.
2.	Largo RD, Tchang LA, Mele V, et al. Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review. J Plast Reconstr Aesthet Surg, 2014, 67(4): 437-448.
3.	Hivernaud V, Lefourn B, Robard M, et al. Autologous fat grafting: A comparative study of four current commercial protocols. J Plast Reconstr Aesthet Surg, 2017, 70(2): 248-256.
4.	Mu DL, Luan J, Mu L, et al. Breast augmentation by autologous fat injection grafting: management and clinical analysis of complications. Ann Plast Surg, 2009, 63(2): 124-127.
5.	Eto H, Kato H, Suga H, et al. The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg, 2012, 129(5): 1081-1092.
6.	Arleo EK, Saleh M, Schwartz MH, et al. Cosmetic fat augmentation following breast reconstruction: sonographic appearance with cytopathologic correlation. Clin Imaging, 2014, 38(6): 872-876.
7.	Pu LL. Mechanisms of fat graft survival. Ann Plast Surg, 2016, 77 Suppl 1: S84-S86.
8.	Rao A, Saadeh PB. Defining fat necrosis in plastic surgery. Plast Reconstr Surg, 2014, 134(6): 1202-1212.
9.	Tayyab SJ, Adrada BE, Rauch GM, et al. A pictorial review: multimodality imaging of benign and suspicious features of fat necrosis in the breast. Br J Radiol, 2018, 91(1092): 20180213. doi: 10.1259/bjr.20180213.
10.	Knackstedt RW, Gatherwright J, Ataya D, et al. Fat grafting and the palpable breast mass in implant-based breast reconstruction: incidence and implications. Plast Reconstr Surg, 2019, 144(2): 265-275.
11.	Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction. Ann Plast Surg, 2013, 70(5): 553-556.
12.	Chala LF, de Barros N, de Camargo Moraes P, et al. Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings. Curr Probl Diagn Radiol, 2004, 33(3): 106-126.
13.	Shida M, Chiba A, Ohashi M, et al. Ultrasound diagnosis and treatment of breast lumps after breast augmentation with autologous fat grafting. Plast Reconstr Surg Glob Open, 2017, 5(12): e1603. doi: 10.1097/GOX.0000000000001603.
14.	Yoshimura K, Coleman SR. Complications of fat grafting: how they occur and how to find, avoid, and treat them. Clin Plast Surg, 2015, 42(3): 383-388.
15.	Veber M, Tourasse C, Toussoun G, et al. Radiographic findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg, 2011, 127(3): 1289-1299.
16.	Freer PE, Wang JL, Rafferty EA. Digital breast tomosynthesis in the analysis of fat-containing lesions. Radiographics, 2014, 34(2): 343-358.
17.	Carvajal J, Patiño JH. Mammographic findings after breast augmentation with autologous fat injection. Aesthet Surg J, 2008, 28(2): 153-162.
18.	Yoshimura K, Sato K, Aoi N, et al. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg, 2008, 32(1): 48-55.
19.	Zheng DN, Li QF, Lei H, et al. Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg, 2008, 61(7): 792-798.
20.	Zocchi ML, Zuliani F. Bicompartmental breast lipostructuring. Aesthetic Plast Surg, 2008, 32(2): 313-328.
21.	Fiaschetti V, Pistolese CA, Fornari M, et al. Magnetic resonance imaging and ultrasound evaluation after breast autologous fat grafting combined with platelet-rich plasma. Plast Reconstr Surg, 2013, 132(4): 498e-509e.
22.	Adejolu M, Huo L, Rohren E, et al. False-positive lesions mimicking breast cancer on FDG PET and PET/CT. AJR Am J Roentgenol, 2012, 198(3): W304-W314.
23.	Mineda K, Kuno S, Kato H, et al. Chronic inflammation and progressive calcification as a result of fat necrosis: the worst outcome in fat grafting. Plast Reconstr Surg, 2014, 133(5): 1064-1072.
24.	Lin JY, Song P, Pu LLQ. Management of fat necrosis after autologous fat transplantation for breast augmentation. Plast Reconstr Surg, 2018, 142(5): 665e-673e.
25.	Qu S, Zhang W, Zhang J, et al. The vacuum-assisted breast biopsy system is an effective treatment strategy for breast lumps after augmentation with autologous fat grafting. Aesthetic Plast Surg, 2019, 43(5): 1152-1157.
26.	Kronowitz SJ, Mandujano CC, Liu J, et al. Lipofilling of the breast does not increase the risk of recurrence of breast cancer: a matched controlled study. Plast Reconstr Surg, 2016, 137(2): 385-393.
27.	Chopan M, White JA, Sayadi LR, et al. Autogenous fat grafting to the breast and gluteal regions: safety profile including risks and complications. Plast Reconstr Surg, 2019, 143(6): 1625-1632.
28.	Hanson SE, Kapur SK, Garvey PB, et al. Oncologic safety and surveillance of autologous fat grafting following breast conservation therapy. Plast Reconstr Surg, 2020, 146(2): 215-225.
29.	Doren EL, Parikh RP, Laronga C, et al. Sequelae of fat grafting postmastectomy: an algorithm for management of fat necrosis. Eplasty, 2012, 12: e53.
30.	Garsa AA, Ferraro DJ, Dewees T, et al. Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer. Brachytherapy, 2013, 12(2): 99-106.
31.	Kang D, Luan J. Fat necrosis after autologous fat transfer (AFT) to breast: comparison of low-speed centrifugation with sedimentation. Aesthetic Plast Surg, 2018, 42(6): 1457-1464.
32.	Lin Y, Yang Y, Mu D. Fat processing techniques: a narrative review. Aesthetic Plast Surg, 2021, 45(2): 730-739.
33.	Minn KW, Min KH, Chang H, et al. Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthetic Plast Surg, 2010, 34(5): 626-631.
34.	Asilian A, Siadat AH, Iraji R. Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat. J Res Med Sci, 2014, 19(6): 556-561.
35.	Rubin A, Hoefflin SM. Fat purification: survival of the fittest. Plast Reconstr Surg, 2002, 109(4): 1463-1464.

1. Groen JW, Negenborn VL, Twisk DJWR, et al. Autologous fat grafting in onco-plastic breast reconstruction: A systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction. J Plast Reconstr Aesthet Surg, 2016, 69(6): 742-764.
2. Largo RD, Tchang LA, Mele V, et al. Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review. J Plast Reconstr Aesthet Surg, 2014, 67(4): 437-448.
3. Hivernaud V, Lefourn B, Robard M, et al. Autologous fat grafting: A comparative study of four current commercial protocols. J Plast Reconstr Aesthet Surg, 2017, 70(2): 248-256.
4. Mu DL, Luan J, Mu L, et al. Breast augmentation by autologous fat injection grafting: management and clinical analysis of complications. Ann Plast Surg, 2009, 63(2): 124-127.
5. Eto H, Kato H, Suga H, et al. The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg, 2012, 129(5): 1081-1092.
6. Arleo EK, Saleh M, Schwartz MH, et al. Cosmetic fat augmentation following breast reconstruction: sonographic appearance with cytopathologic correlation. Clin Imaging, 2014, 38(6): 872-876.
7. Pu LL. Mechanisms of fat graft survival. Ann Plast Surg, 2016, 77 Suppl 1: S84-S86.
8. Rao A, Saadeh PB. Defining fat necrosis in plastic surgery. Plast Reconstr Surg, 2014, 134(6): 1202-1212.
9. Tayyab SJ, Adrada BE, Rauch GM, et al. A pictorial review: multimodality imaging of benign and suspicious features of fat necrosis in the breast. Br J Radiol, 2018, 91(1092): 20180213. doi: 10.1259/bjr.20180213.
10. Knackstedt RW, Gatherwright J, Ataya D, et al. Fat grafting and the palpable breast mass in implant-based breast reconstruction: incidence and implications. Plast Reconstr Surg, 2019, 144(2): 265-275.
11. Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction. Ann Plast Surg, 2013, 70(5): 553-556.
12. Chala LF, de Barros N, de Camargo Moraes P, et al. Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings. Curr Probl Diagn Radiol, 2004, 33(3): 106-126.
13. Shida M, Chiba A, Ohashi M, et al. Ultrasound diagnosis and treatment of breast lumps after breast augmentation with autologous fat grafting. Plast Reconstr Surg Glob Open, 2017, 5(12): e1603. doi: 10.1097/GOX.0000000000001603.
14. Yoshimura K, Coleman SR. Complications of fat grafting: how they occur and how to find, avoid, and treat them. Clin Plast Surg, 2015, 42(3): 383-388.
15. Veber M, Tourasse C, Toussoun G, et al. Radiographic findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg, 2011, 127(3): 1289-1299.
16. Freer PE, Wang JL, Rafferty EA. Digital breast tomosynthesis in the analysis of fat-containing lesions. Radiographics, 2014, 34(2): 343-358.
17. Carvajal J, Patiño JH. Mammographic findings after breast augmentation with autologous fat injection. Aesthet Surg J, 2008, 28(2): 153-162.
18. Yoshimura K, Sato K, Aoi N, et al. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg, 2008, 32(1): 48-55.
19. Zheng DN, Li QF, Lei H, et al. Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg, 2008, 61(7): 792-798.
20. Zocchi ML, Zuliani F. Bicompartmental breast lipostructuring. Aesthetic Plast Surg, 2008, 32(2): 313-328.
21. Fiaschetti V, Pistolese CA, Fornari M, et al. Magnetic resonance imaging and ultrasound evaluation after breast autologous fat grafting combined with platelet-rich plasma. Plast Reconstr Surg, 2013, 132(4): 498e-509e.
22. Adejolu M, Huo L, Rohren E, et al. False-positive lesions mimicking breast cancer on FDG PET and PET/CT. AJR Am J Roentgenol, 2012, 198(3): W304-W314.
23. Mineda K, Kuno S, Kato H, et al. Chronic inflammation and progressive calcification as a result of fat necrosis: the worst outcome in fat grafting. Plast Reconstr Surg, 2014, 133(5): 1064-1072.
24. Lin JY, Song P, Pu LLQ. Management of fat necrosis after autologous fat transplantation for breast augmentation. Plast Reconstr Surg, 2018, 142(5): 665e-673e.
25. Qu S, Zhang W, Zhang J, et al. The vacuum-assisted breast biopsy system is an effective treatment strategy for breast lumps after augmentation with autologous fat grafting. Aesthetic Plast Surg, 2019, 43(5): 1152-1157.
26. Kronowitz SJ, Mandujano CC, Liu J, et al. Lipofilling of the breast does not increase the risk of recurrence of breast cancer: a matched controlled study. Plast Reconstr Surg, 2016, 137(2): 385-393.
27. Chopan M, White JA, Sayadi LR, et al. Autogenous fat grafting to the breast and gluteal regions: safety profile including risks and complications. Plast Reconstr Surg, 2019, 143(6): 1625-1632.
28. Hanson SE, Kapur SK, Garvey PB, et al. Oncologic safety and surveillance of autologous fat grafting following breast conservation therapy. Plast Reconstr Surg, 2020, 146(2): 215-225.
29. Doren EL, Parikh RP, Laronga C, et al. Sequelae of fat grafting postmastectomy: an algorithm for management of fat necrosis. Eplasty, 2012, 12: e53.
30. Garsa AA, Ferraro DJ, Dewees T, et al. Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer. Brachytherapy, 2013, 12(2): 99-106.
31. Kang D, Luan J. Fat necrosis after autologous fat transfer (AFT) to breast: comparison of low-speed centrifugation with sedimentation. Aesthetic Plast Surg, 2018, 42(6): 1457-1464.
32. Lin Y, Yang Y, Mu D. Fat processing techniques: a narrative review. Aesthetic Plast Surg, 2021, 45(2): 730-739.
33. Minn KW, Min KH, Chang H, et al. Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthetic Plast Surg, 2010, 34(5): 626-631.
34. Asilian A, Siadat AH, Iraji R. Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat. J Res Med Sci, 2014, 19(6): 556-561.
35. Rubin A, Hoefflin SM. Fat purification: survival of the fittest. Plast Reconstr Surg, 2002, 109(4): 1463-1464.

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