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Fat Grafting to the Reconstructed Breast: The Use of 3D Imaging to Evaluate Volume Retention
Chaya Levovitz, BA, Nolan Karp, MD, Mihye Choi, MD. Institute of Reconstructive Plastic Surgery, New York, NY, USA.
Background: Fat grafting (FG) has become a common adjunctive procedure in patients undergoing autologous and implant breast reconstruction and is also used to treat contour deformities from lumpectomy surgery. In this study, 50 patients underwent FG into 67 breasts. There were 24 autologous breast reconstructions, 34 implant reconstructions, and 9 lumpectomy defects. Preoperative 3D scans were obtained on all patients and a calculated volume deficit was determined for each breast. Methods: FG surgery was performed using a modified Coleman technique to achieve symmetry. The patients were followed postoperatively to determine the success of the FG procedure. 3D imaging was performed using the Canfield VECTRA system and analyzed using Geomagic software. Breast volume was calculated for each breast on every scan. Results: The data stratified patients into 3 groups with statistically significant parameters based on the volume of fat injected. The group that received the largest volume of FG had an average injection volume of 144cc [111cc-208cc], lost 2.4% of volume/day the 1st postoperative week (POW), 1.3% of volume/ day over the 2nd and 3rd POW, and experienced volume stability at post-operative day (POD)67 with a volume retention of 51%. These findings significantly contrast with the patients receiving smaller volume FG, who had an average injection volume of 47cc [11cc-74cc], lost 1.8% of volume/day the 1st POW, 1.6% of volume/day over the 2nd and 3rd POW, and did not experience volume stability until POD 120 with 39% volume retention. The third patient group received an intermediate volume of FG with an average injected volume of 95cc [81cc-108cc], lost 2.10% of volume/day the 1st POW, 1.30% of volume/day over the 2nd and 3rd POW, and experienced volume stability at POD 77 with 42% volume retention. Radiation did not seem to affect the volume retention rate of any of the three patient groups. Conclusions: Our data suggests fat retention is volume and time dependent. Patients receiving >110cc of FG lost the greatest percentage of volume the first POW and then the rate of volume loss tapered until volume retention stabilized to half the total volume injected around 2 months PO. Patients receiving smaller volumes of FG take longer to reach volume stability and have lower rates of volume retention. Radiation therapy does not seem to affect FG results.
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