Why fat grafting for breast augmentation is problematic.
The use of a patient’s own fat for augmentation and fill (autologous fat grafting) has gained popularity in recent years. Autologous fat grafting is a very useful procedure, in particular for augmentation of the facial skeleton, and buttocks (Brazilian butt lift) during cosmetic and reconstructive procedures. The use of autologous fat grafting is a successful progression from our success and refinement of liposuction techniques. Outside of the United States, plastic surgeons have begun using fat grafting for augmentation of the breast as well. However, plastic surgeons within the U.S. have not yet begun utilizing fat grafting to the breast for cosmetic purposes , instead reserving it as a secondary procedure in reconstruction cases following mastectomy.
While very useful, one of the risks of fat grafting is the development of fat necrosis. Fat necrosis is a condition where fat cells die off as a result of being deprived of adequate blood supply. While some fat cells will liquify and dissolve, others will heal in through the process of scar formation. Although rarely visible, this scar formation can present as a palpable lump. Further, during the process of fat necrosis, small calcifications can form within the scar tissue. This can be problematic should it occur in the breast because it interferes with our ability to properly perform screening mammography since calcifications that result from fat necrosis appear similar to calcifications that occur with some breast cancers.
A recent study in Beijing reviewed just this topic (Wang, et al. Plast Recon Surg. Vol 127, No.4 April, 2011, p1669). This group evaluated 48 patients who had undergone cosmetic autologous fat injection for breast augmentation over a ten year period. Eight of these patients (16.7%) developed microcalcifications on their mammogram. These calcifications were highly suspicious for breast carcinoma, obligating all of the women to a breast biopsy procedure. Although the pathological evaluation found fat necrosis (and not carcinoma) in these specimens, these eight women required a surgical procedure in order to adequately evaluate their breast and rule out the possibility of carcinoma.