Abstract: Identifying Risk Factors for Fat Necrosis After Autologous Fat Transplantation to the Breast

Abstract

PURPOSE: Fat necrosis is a concerning complication after autologous fat grafting for breast reconstruction and aesthetic augmentation. It can present as a palpable mass concerning for malignancy. As such, we sought to evaluate risk factors for fat necrosis and identify methods for prevention. METHODS: We reviewed 83 consecutive patients who underwent large volume fat transplantation to the breast performed by the senior author between September 2011-May 2015. Patients with a minimum of 100cc of transplanted fat were included. RESULTS: A total of 148 breasts underwent 170 autologous fat transplantations. Indications included 72 reconstructions after surgical therapy for breast cancer and 98 cosmetic augmentations. BRAVA was used in 133 cases- 45 reconstructions and 88 augmentations. Twenty-three cases had previous radiation therapy. Seventeen breasts had simultaneous implant exchange with fat (SIEF). Mean age was 48 years, with average graft volume of 336.9cc (100 - 1000), and average length of follow-up 485 days (14 - 1219). Overall incidence of necrosis was 32.9%, with 47.8% in irradiated patients compared to 30.6% in nonirradiated patients. Increased rates of necrosis were demonstrated in groups with fat grating volumes over 500cc (p=0.001) and those who underwent SIEF(p=0.003). Within a group of six patients that had bilateral fat grafting with unilateral radiation, there was a significant increase in necrosis on the radiated side (p=0.015). In a cohort of non-BRAVA patients, reconstruction (compared to augmentation) was associated with necrosis (p=0.036). CONCLUSION: In this study, increased rates of fat necrosis were associated with volumes greater than 500cc, SIEF, radiation, and non-BRAVA reconstruction.