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A Classification System for Fat Necrosis in Autologous Breast Reconstruction
Winnie T. Tong, MD1, Andrea Bazakas, MS2, Eric G. Halvorson, MD3.
1MD Anderson Cancer Center, Houston, TX, USA, 2University of North Carolina, Chapel Hill, NC, USA, 3Harvard Medical School, Boston, MA, USA.
Introduction
Fat necrosis (FN) is a very common complication of autologous breast reconstruction, yet no descriptive classification system exists. We sought to develop a simple tool for meaningful reporting, comparison of techniques, and treatment planning.
Methods
A classification system for fat necrosis was developed (Figs. 1-3). For validation, we performed a retrospective chart review of patients who underwent pedicled transverse rectus abdominis myocutaneous flaps (pTRAM) from 2002-2006 and perforator flaps (PF) from 2006-2010 at our institution. Our hypothesis was that a valid classification system should demonstrate higher grades of FN for pTRAM.
Results
We performed 93 pTRAM in 69 patients and 102 PF in 69 patients. The distribution of FN differed between pTRAM and PF (Fig. 4). The mean FN grade for patients undergoing pTRAM was 1.4 vs. 0.4 for those undergoing PF (p<0.05). Observation was more common in lower grades, and debridement was more common in higher grades (Fig. 5). FN requiring reoperation was more frequent in the pTRAM group (23.7% vs. 5.9%, p<0.05).
Conclusions
Our validation study confirmed that FN grade was associated with need for surgery and was higher for pTRAM as expected. As it is similar to the Baker grading system for capsular contracture, this qualitative classification system is familiar to all plastic surgeons. It is simple, easy to remember, clinically oriented, and could readily be incorporated into outcome studies.
 
  
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