Background: Fat grafting has emerged as a useful method for breast contouring in aesthetic and reconstructive patients. Various advancements have been made in the techniques of fat graft harvest and delivery, but our ability to judge the overall success of fat grafting remains limited. Issues that have yet to be resolved include: fat graft viability, preservation of breast shape over time, and possible migration of the grafted tissue. Previously, we reported the use of three-dimensional (3D) imaging to assess breast morphology in patients undergoing reduction mammaplasty, breast augmentation, and breast reconstruction. The following study applies similar 3D imaging technology to assess the stability of breast shape following autologous fat transfer to the breast.

Materials and Methods: As previously described, breasts were isolated as closed objects and total breast volume was calculated. In addition, a method of quadrant-based analysis was established using horizontal and vertical planes through the nipple in order to divide the breast into four quadrants; superolateral (SL), superomedial (SM), inferolateral (IL), and inferomedial (IM).  After validating a system for determining absolute and percent volume calculations of each quadrant, these techniques were applied to patients undergoing autologous fat transfer to the breast. 3D scans were scheduled preoperatively and at postoperative weeks 1, 2, 3, 4, 8, and monthly thereafter.

Results: Seven patients are currently enrolled in the study. The patients were stratified to the following groups:  Primary breast augmentation, Augmentation of autologous breast reconstruction, or Augmentation of implant breast reconstruction.  At the time of this abstract submission, the longest postoperative follow up available was 12 weeks.  In all cases, the volume of the fat grafted breast was stable for the first four weeks postoperative.  By the eighth postoperative week, there was an average 6.5% decrease in breast volume from the first postoperative scan (one week after surgery).  By 12 weeks, the volume decrease was 9.9%.  Longer term data will be presented as the patients will be scanned monthly going forward.  A TRAM flap patient, who was augmented with fat to correct volume deficiency, was noted to have redistribution of the volume in the breast from the upper quadrants to the lower quadrants by week 12.  All other patients did not have redistribution of volume within the breast during the first 12 postoperative weeks.

Conclusions: This study demonstrates that 3D imaging can be used to objectively assess the post-operative results of fat grafting to the breast. The data suggests that patients undergoing fat transfer to the breast may have stable volume for the first four postoperative weeks.  For the next eight weeks the patients appear to undergo a period of resorption. In one case, there was a redistribution of volume within the breast. Additional long-term studies are pending to help define the survival of the fat grafts and whether breast shape is preserved.