Outcomes following high- versus low-volume fat transfer following breast reconstruction and conservation—the Canniesburn Experience

Abstract

Fat transfer is increasingly being used following oncological breast surgery to improve contour irregularities, provide symmetry and treat radiotherapy changes. Our study aims to compare patients receiving high-volume (HV) (> 200 mls of fat transferred in one session) versus low-volume (LV) (< 200 mls fat transferred per session) fat transfer to determine differences in outcomes using these two approaches. A retrospective review was performed for patients undergoing lipomodelling for breast reconstruction from 2005 to 2018. Data collected included patient demographics, type of reconstruction, number of lipomodelling sessions and volume of aspirate and fat reinjected. The primary endpoints were a comparison of complication rates, need for additional imaging and biopsies and cancer recurrence between the two groups. Secondary endpoints were a subgroup analysis of the patients who had received radiotherapy in each group for the above parameters. Two hundred fifty-seven patients underwent 407 episodes of LV and 126 patients underwent 179 episodes of HV fat transfer. Patients were matched for body mass index (BMI), ASA grade and smoking status. The donor site had a higher rate of complications following HV fat transfer (4.47 vs. 1.47%; p = 0.029*). There were no significant differences in the requirement for additional imaging and biopsies and tumour recurrence between the two groups. Secondary endpoints: No significant differences in recipient site complication rates and need for further imaging and biopsies were noted in patients receiving radiotherapy. HV fat transfer was associated with an increased donor site morbidity; however, it is acceptable in suitable patients following radiotherapy. Level of evidence III, therapeutic study