Commentary on: Long-term follow-up of cadaveric breast augmentation: what can we learn?

Abstract

This article on long-term follow-up of cadaveric breast augmentation is admirable, for the authors not only report their observations on an interesting and (to me) hitherto unknown procedure, but also take the next step in the spirit of the surgeon-scientist in postulating a hypothesis and posing research questions arising from their observations.1 Macroscopic autologous fat grafts, more commonly dermis-fat grafts, were the standard method of soft tissue filler from early times, and although high failure rates were doubtless anticipated, compared to the complex multi-staged tube pedicle migration and its associated scarring and morbidity, the free graft seems to have been a reasonable reconstructive option. Free microsurgical one-stage transfers wrote the death knell for large-segment free-fat grafting. Knowing that autografts fared poorly and that immune rejection could only worsen the anticipated survival rates, allografts of non-vascularized whole fat pieces seem optimistic. The authors trace the main practitioners of the procedure to Russia and Eastern Europe, where there was perhaps less structured training and less scrutiny at that time. Naive painters were similarly ignorant of the rigid tenets of the academy, but under such freedom original ideas take flight, some with a core of genius. The authors have sought to unravel the question: was this procedure naive, foolish, or genius? From the clinical photographs 15 years post-transplantation, it appears that a large amount of tissue has been retained bilaterally, irrespective of its complications, perhaps more than might have been expected even with an autograft, …