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Assessment of Long-Term Volume Retention in Autologous Fat Grafting for Breast Reconstruction: A Randomized Controlled Trial Comparing Lipoaspirate Processing Techniques
Makayla Kochheiser
*, Sophia Arbuiso, Nancy Qin, Lucy Wei, Anna M. Vaeth, Kristy A. Brown, David Otterburn
Weill Cornell Medical College, New York, NY
Background: Autologous fat grafting (AFG) is commonly used in breast reconstruction for volume restoration or contour correction. Our previous study demonstrated that standard decantation yields inferior volume retention compared to active-wash and filtration (AWF) and low-pressure (LP) decantation. Building upon these findings, we replaced standard decantation with a new processing technique, active-wash with surfactant (AWS). This study aims to evaluate long-term volume retention among AWF, LP decantation, and AWS.
Methods: A prospective, randomized controlled trial was conducted at our institution between 2023 and 2025. Thirty patients were randomized in a 1:1:1 ratio to receive fat grafting processed by either active-wash and filtration (AWF), low-pressure (LP) decantation, or active-wash with surfactant (AWS). Three-dimensional scans of the upper torso were obtained preoperatively and at 3 months postoperatively. Breast volume was measured using Autodesk Meshmixer, and volume retention was calculated as a percentage of the initial grafted volume. Differences in volume retention across groups were analyzed using one-way ANOVA.
Results: The volume of fat injected during the procedure did not differ significantly between groups: 89.0 cc ± 56.0 cc for AWF, 125.8 cc ± 68.9 cc for LP decantation, and 127.5 cc ± 78.7 cc for AWS (p=0.33). Average volume retention at 3 months was 55.3% ± 17.2% for AWF, 58.7% ± 17.8% for LP decantation, and 62.7% ± 15.7% for AWS. No significant difference in volume retention was observed across groups (p=0.52).
Conclusion: Although AWS demonstrated the highest average volume retention, differences between techniques were not statistically significant. These findings suggest comparable long-term outcomes among the three processing methods.
Figure 1. Distribution of volume retention (%) across lipoaspirate processing techniques: a) active-wash and filtration, b) low-pressure decantation, and c) active wash with surfactant.
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