Is There An Ideal Donor Site of Fat for Secondary Breast Reconstruction?

Introduction

Previous work has documented the validity of 3D imaging to assess surgical outcomes of autologous fat grafting (FG). (1) However, minimal research exists to quantify the ideal donor site of fat for secondary breast reconstruction. (2, 3) Millard argued in Principilization of Plastic Surgery that tissue losses should be replaced in kind; thus, theoretically, plastic surgeons should harvest adipose tissue from neighboring donor sites to optimize aesthetic results. (4)  The following study compares fat graft survival from two distinctive anatomical sites utilizing three-dimensional imaging.

Methods

All patients receiving fat grafting to the reconstructed breast from 2009-2012 were enrolled in the study. The patients were divided into two groups depending on the donor site: Group A had fat harvested from the abdomen and Group B from the thighs.  FG surgery was performed using a modified Coleman technique to achieve symmetry. Preoperative and post-operative 3D scans were obtained on all patients. 3D imaging was performed using the Canfield VECTRA system and analyzed using Geomagic software. As previously described, breasts were isolated as closed objects and total breast volume was calculated on every scan.

Results

In the observed time period, a total of 88 patients (135 breasts) received autologous fat transfer and associated 3D images.  46 patients (66 breasts) averaged 101.17cc of fat injected from the abdomen, and 27 patients (43 breasts) averaged 101.98cc of fat injected from the thighs. The patients who received fat graft from both the abdomen and thighs were excluded from the study (15 patients, 26 breasts).   Group A had 86.70% volume retention at 7 days postoperatively, 81.98% at 16 days, 63.15% at 49 days, and 44.63% at 140 days.  Group B had 94.56% volume retention at 7 days, 85.80% at 16 days, 62.71% 49 at days, and 46.43% at 140 days.  No statistical difference was found at any time points.

Conclusions

Our data suggests that the fat graft donor site does not affect percent volume retention. Longer-term studies are needed to assess the stability of the breast after autologous fat transfer.