Volumetric evaluation of fat resorption after breast lipofilling

Abstract

The fat transfer or the lipofilling is a technique that had a major impact on the breast surgery results. We have been using this technique since 1998 as an adjuvant in breast reconstruction. The transferred fat is partially resorbed in the first three months after fat grafting. Literature shows that fat resorption varies from 30 to 80% and the experimental studies register a variation between 50 and 90%. The difficulty of the lipomodeling consists in anticipating the fat resorption rate in order to obtain breast symmetry. The purpose of this article is to evaluate the resorption rate of the transferred fat in the reconstructed breast by means of volumetric imaging 3 months after fat grafting. A prospective study was undertaken including breast reconstructions with total autologous latissimus dorsi. All the surgical procedures have been done by the same surgeon (1st author). It focused on the second stage of breast reconstruction: the lipofilling. We registered the average harvested volumes, the volumes obtained after centrifugation and the transferred volumes for every reconstructed breast. The intramuscular volume in the reconstructed breast was measured by volumetric imaging on the third day after lipofilling (D3) and three months after lipofilling (M3). The volumetry was performed by using an after treatment console SIEMENS (SOMATOM definition AS 2*64 barettes). The average intramuscular volume was registered at D3 and M3. The average volume difference was calculated in order to obtain the exact resorption rate. This prospective study was undertaken on 32 reconstructed breasts by total autologous latissimus dorsi flap. The average age was 52 years, the average BMI was 24.7 kg/m(2). The average harvested fat volume for the breast lipofilling was 560 cc and the volume obtained after centrifugation was evaluated at about 371 cc, the average fat volume transferred being 291 cc. The volumetric study showed that intramuscular volume at D3 was measured at 284 cc and at M3 about 223 cc, of a resorption intramuscular rate of 21.5%. In our study, the rate of resorption of the fat transferred to the muscle in the reconstructed breast was measured at 21.5%. The low resorption rate found in our study, lower than those in the literature, sustains the supposition that the muscle is an excellent receiving matrix for the fat tissue. In order to obtain this percentage, a learning curve is necessary. Once acquired, this technique produces a major improvement of the breast surgery results.