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Pure Fat Grafting for Breast Reconstruction: An Alternative Autologous Breast Reconstruction
Pathik Aravind, M.B.B.S, Charalampos Siotos, MD, Vishnu Prasath, MS, Amanda Rubano, MS, Mehran Habibi, MD, Michele Manahan, MD, MBA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND: Plastic surgeons offer various options for breast reconstruction. Despite multiple advancement in implant and autologous based breast reconstruction there remains some concerns regarding their use such as lymphoma associated with implant-based reconstruction and donor site morbidity with flap-based reconstruction. In this context, an alternative form of breast reconstruction arose, which includes tissue expansion with tissue expander and subsequent fat grafting without the use of implant or flap. We sought to evaluate the technique of pure fat grafting for breast reconstruction and assess complications and quality of life outcomes. METHODS: We retrospectively reviewed our prospective database of breast cancer patients who underwent breast reconstruction at our institution. Patients who underwent pure fat grafting were identified. All patients underwent internal expansion with traditional saline expanders followed by reconstruction by pure fat grafting. Demographic information, complications, operative details, and BREAST-Q scores were abstracted from patientsí records. BREAST-Qs were administered at 4 different time points - Pre-operatively, 6 weeks after tissue expander insertion, 6 and 12 months after final reconstruction.
RESULTS: : From 2009-2015, 10 patients underwent pure fat grafting for breast reconstruction at our institution of which 4 were unilateral and 6 were bilateral. Patients were followed-up to a minimum of 12 months.
In the four patients who underwent a unilateral mastectomy followed by pure fat graft a median of 4.5 sessions were required with a total median fat grafting volume of 380 cubic centimeters. In the six patients who underwent bilateral mastectomy followed by pure graft bilaterally, a median of 5.5 session were required. A median total of 974.5 cubic centimeters of fat was grafted in both breasts combined. The median fat graft volume per session was 158 cubic centimeters. Patients experienced no complications related to the fat grafting procedures. In addition, no breast cancer recurrences were noted with a follow-up of at least 12 months. Finally, Breast Q scores at the 12-month follow-up presented only minimal variation from the pre-operative values.
CONCLUSIONS: In our select group of patients, pure fat grafting was not seen to be associated with any procedure related complications or major change in patientsí quality of life. We also believe that this technique can be performed with the use of traditional internal tissue expansion without the need for external expansion. Therefore, pure fat grafting presents as a viable option for breast reconstruction, especially in patients who do not desire or have contraindications to implant or flap-based reconstruction.

Comparison of Pre-operative and 12-month BREAST-Q scores using Wilcoxon Signed-rank test
DomainPre-Operative Scores12-month ScoresDeltap-value
MedianIQRMedianIQRMean
Satisfaction with Breasts74.521-1004535.75-62.75140.386
Psychosocial well-being7356.5 - 89.56652.75 - 74.55.70.153
Sexual well-being60.540.75 - 68.2549.544 - 60.756.80.139
Physical well-being: Chest8171.75 - 1008160 - 95.550.286
Physical well-being: Abdomen10095.75 - 100----


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