Current Fat Grafting Practices for Cosmetic and Reconstructive Breast Surgery: A National Survey of ASPS Members

Introduction

Fat grafting is a popular procedure for breast surgeons yet variable techniques and results are reported.¹  We surveyed members of the American Society of Plastic Surgery to elucidate current practice patterns and opinions to identify priorities for future investigation.

Methods

Six thousand letters were mailed (February 2012) followed several weeks later by a reminder e-mail to the 5,942 members.  Polling was closed on May 30, 2012 with 590 responses and 527 fully completed surveys.

Results

A large majority of responders perform this procedure (n=380, 69.3%).  Safety concerns were cited as the most common reason for not performing fat grafting (43.4%).  The majority of surgeons performed fat grafting for reconstructive (96.3%) indications with most avoiding the contralateral breast (72.7%).  Reconstruction included deformities due to lumpectomy (64.1%) or mastectomy (66.6%), contour irregularities following implant reconstruction (93.4%) or following tissue reconstruction (88.4%).  Cosmetic indications included augmentation with implant (45.5%) and without implant (48.5%), contour deformities post-augmentation (82.2%), and tuberous breast deformity (25.7%). The preferred donor site was the abdomen (79.9%), then thighs, flanks/back, gluteal region, arms, and knees.  The top three fat harvesting techniques were manual aspiration (49.6%), wet liposuction (27.9%), and Lipivage (8.4%).  Most employ tumescent solution (78.3%) or local anesthetic (11.4%).  Liposuction cannulas are preferred over the syringe/needle for harvest (92.7 vs. 7.3%).  Various cannulas are used: Coleman microcannula (21.5%), 1 mm (5.9%), 2 mm (29.4%), 3 mm (47.1%), 4 mm (22.6%), 5 mm (2.4%), and other (1.2%).  Fat processing was predominantly centrifugation (28.5%) and filtration (42.4%) using telfa/gauze or strainer.  Use of fat freezing for delayed use (2.2%) or stem-cell enrichment techniques (3.3%) was uncommon.  Most surgeons (56.4%) believed fat survival is 50-75% and only 7.9% believe survival is 75-100%.  Overcorrection is routinely performed by 78.2% of surgeons and they report adding up to 25% volume (69.7%), 25-50% (27.9%), and >50% (2.4%).  Repeat sessions were performed mostly at 3-6 months (45.8%).

Conclusions

Fat grafting is a promising surgical technique for breast surgeons but lacks standardization in clinical practice.  Further studies are needed to define optimal techniques in fat harvesting, donor-site selection, fat processing, injection technique/volume, and timing to improve safety and obtain reliable results.