Monica Y Ciencias

COSMETIC
Complications after Autologous Fat Injection to the Breast
Hiko Hyakusoku, M.D., Ph.D. Rei Ogawa, M.D., Ph.D. Shimpei Ono, M.D. Nobuaki Ishii, M.D. Keiko Hirakawa, Ph.D.
Tokyo, Japan

Background: Although autologous fat injection (fat grafting) to the breast was performed widely throughout the twentieth century, the authors at their hospital have recently had to repair the damagesuffered by a number of patients subjected to this procedure. The authors are concerned that this procedure is being performed incorrectly by untrained and untutored individuals, especially in Japan. The authors report several cases of complications after this procedure. Several related issues are discussed. Methods: The authors retrospectively reviewed 12 patients who had received autologous fatgrafts to the breast and required breast surgery and/or reconstruction to repair the damage presenting between 2001 and 2007. The symptoms are described and the fat grafting procedures that were used are analyzed. Results: All 12 patients (mean age, 39.3 years) had received fat injections to the breast for augmentation mammaplasty for cosmetic purposes. They presented with palpable indurations,three with pain, one with infection, one with abnormal breast discharge, and one with lymphadenopathy. Four cases had abnormalities on breast cancer screening. All patients underwent mammography, computed tomography, and magnetic resonance imaging to evaluate the injected fats. Conclusions: Autologous fat grafting to the breast is not a simple procedure and should be performed by well-trained andskilled surgeons. Patients should be informed that it is associated with a risk of calcification, multiple cyst formation, and indurations, and that breast cancer screens will always detect abnormalities. Patients should also be followed up over the long-term and imaging analyses (e.g., mammography, echography, computed tomography, and magnetic resonance imaging) should be performed. (Plast. Reconstr.Surg. 123: 360, 2009.)

utologous fat injection into the breast was performed widely throughout the twentieth century. However, in 1987, the American Society of Plastic and Reconstructive Surgeons indicated that because of the side effects (i.e., tissue scarring, oil cysts, and calcification), autologous fat grafting to the breast might compromise breast cancer surveillance and should thereforebe prohibited.1 Although most plastic and aesthetic surgeons subsequently refrained from performing this procedure, some physicians continued to seek to improve this technique and reported their observations.2–7 In particular, Coleman and Saboeiro showed that structural fat grafting was effective.7 Their procedural modifications were also evaluated by other groups.8 Although such
From theDepartment of Plastic, Reconstructive and Aesthetic Surgery and the NMR Laboratory, Nippon Medical School. Received for publication April 10, 2008; accepted June 20, 2008. Copyright ©2008 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e31819347ba

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studies are scientifically valid, in our hospital, we have had to treat patients with complications resulting from autologous fatinjection to the breast, and we have become concerned that fat grafting to the breast is being performed by untrained and unskilled individuals for profit, especially in some Asian countries, including Japan. To highlight the fact that autologous fat grafting to the breast is not the easy and uncomplicated procedure that it is sometimes believed to be, we here report several cases wherecomplications occurred after autologous fat injection into the breast. We also discuss several issues related to this procedure.

PATIENTS AND METHODS
We reviewed several cases presenting between 2001 and 2007 where the patients had undergone

Disclosure: None of the authors has any financial disclosures.

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Volume 123, Number 1 • Complications after Fat Injection
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