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also be present. Careful placement of grafted fat can supply additional autologous soft-tissue where needed, consisting
of non-radiated cells, to rejuvenate the area in question.
After placement, fat grafting results in angiogenesis into the grafted region, and may improve scar and skin texture.13 The 14 altered vascularity in Raynaud’s,15 and the correction of postsurgical contour irregularities.10-11
Staged approaches allow for correction of these areas over time, help reduce the formation of fat cysts, and increase graft take. Since the area addressed by fat grafting can be tailored to the size and geometry of the particular defect, this provides added versatility versus breast implant prostheses. For larger of fat grafting and implant-based reconstruction are often successfully combined. However in subtotal breast defects, implant placement may accentuate asymmetries between the areas such as shown in this patient example. While this patient was a candidate for implant-based reconstruction, she did not
REFERENCES
1. Cancer Facts & Figures 2014. American Cancer society website. Available at: http://www.cancer.org/research/cancerfactsstatistics/ cancerfactsfigures2014/
2. Breast reconstruction rates rising after mastectomy. Cancer Newsline, March 3, 2014. MD Anderson Cancer Center website. Available at: http://www.mdanderson.org/newsroom/cancer-newsline/cancer- newsline-topics/2014/breast-reconstruction-mastectomy.html
3. Stevens LA, McGrath MH, Druss RG, et al. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73:619–628.
4. Kanchwala SK, Glatt BS, Conant EF, et al. Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities. Plast Reconstr Surg. 2009;124:409–418.
5. Sullivan SR, Fletcher DR, Isom CD, Isik FF. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg. 2008;122:19–28.
6. Kronowitz SA. Current status of implant-based reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 2012;130:513–523e.
7. Choi M, Small K, Levovitz C, et al. The volumetric analysis of fat graft analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg. 2013;131:185-191.
wish to have larger breasts, and there is not currently to my knowledge a custom, partial breast implant which is readily commercially available. Finally, fat grafting is a viable option in patients who would like to avoid a prosthetic device in breast reconstruction, but are loathe to undergo the morbidity and recovery associated with microvascular free-tissue transfer. This patient could have pursued an abdominal, thigh, require inpatient hospital admissions, involve more invasive procedures of longer duration, necessitate more conspicuous donor site scars, and require additional surgical training to perform reliably.
CONTRIBUTING AUTHOR
■ ERIK HOY, MD, MBA is a Plastic Surgeon at Premier Dermatology and Cosmetic Plastic Surgery in Newark, Del.
8. Freshwater MF, Freshwater DM. Questions about Safety of fat grafting in secondary breast reconstruction after cancer. J Plast Reconstr Aesthet Surg. 2011;64:483–484.
9. Fraser JK, Hedrick MH, Cohen SR. Oncologic risks of autologous fat grafting to the breast. Aesthet Surg J. 2011;31:68–75.
10. Gutowski KA; ASPS Fat Graft Task Force. Current applications and safety of autologous fat grafts: A report of the ASPS fat graft task force. Plast Reconstr Surg. 2009;124:272–280.
11. Mizuno H, Hyakusoku H. Fat grafting to the breast and adipose-derived stem cells: Recent scientific consensus and controversy. Aesthet Surg J. 2010;30:381–387.
12. Rubin JP, Coon D, Zuley M, Toy J, et al. Mammographic changes after fat transfer to the breast compared with changes after breast reduction: A blinded study. Plast Reconstr Surg. 2012;129:1029-1038.
13. Garza RM, Paik KJ, Chung MT, et al. Studies in fat grafting, Part III: Fat grafting irradiated tissue — Improved skin quality and decreased fat graft retention. Plast Reconstr Surg. 2014;134:249-257.
14. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: A healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 2007;119:1409–1422; discussion 1423.
15. Bank J, Fuller SM, Henry GI. Fat grafting to the hand in patients with Raynaud phenomenon: A novel therapeutic modality. 2014;133:1109- 1118.
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