Medicina Y Otros

BREAST
Fat Grafting to the Breast Revisited:
Safety and Efficacy
Sydney R. Coleman, M.D.
Alesia P. Saboeiro, M.D.
New York, N.Y.

Background: A 1987 American Society of Plastic and Reconstructive Surgeons
position paper predicted that fat grafting would compromise breast cancer
detection and should therefore be prohibited. However, there is no evidence
that fat grafting to breasts isless safe than any other form of breast surgery. As
discussions of fat grafting to the breast are surfacing all over the world, it is time
to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper.
Methods: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia,postaugmentation deformity, tuberous breast deformity, Poland’s syndrome,
and postmastectomy reconstruction deformities. The technique used was the
Coleman method of fat grafting, which attempts to minimize trauma and place
grafted fat in small aliquots at many levels.
Results: All women had a significant improvement in their breast size and/or
shape postoperatively and all had breasts thatwere soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect
after any breast procedure.
Conclusions: Given these results and reports of other plastic surgeons, free fat
grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination
created by the 1987 positionpaper and judge fat grafting to the breast with the
same caution and enthusiasm as any other useful breast procedure. (Plast.
Reconstr. Surg. 119: 775, 2007.)

F

or over a century, surgeons have used autologous fat to enlarge and reshape breasts.
In 1895, Czerny performed the first documented breast augmentation by transplanting a
lipoma from the lumbar region to a breast
defect.1 In theearly twentieth century, Lexer
described placing a graft “as large as two fists”
into a breast, with an excellent result 3 years
later.2 Others have described transplanting fat to
the breast; however, none of the techniques ever
became widely used. In the early 1980s, liposuction provided us with a new potential source of
autologous tissue for breast augmentation, and
surgeons soondescribed placement of the fatty
tissue removed with liposuction into the
breast.3– 6
From the New York University School of Medicine.
Received for publication February 21, 2006; accepted July
18, 2006.
Presented at the American Association of Plastic Surgeons
meeting, in Hilton Head, South Carolina, on May 9, 2006.
Copyright ©2007 by the American Society of Plastic Surgeons
DOI:10.1097/01.prs.0000252001.59162.c9

After Mel Bircoll described his fat grafting at the
California Society of Plastic Surgeons in 1985,3,4 a
heated discussion over the safety of fat grafting to
the breast ensued at regional and national meetings. In 1987, the American Society of Plastic and
Reconstructive Surgeons Ad-Hoc Committee on
New Procedures issued a position paper stating the
following: “Thecommittee is unanimous in deploring the use of autologous fat injection in breast
augmentation [underlined in position paper].
Much of the injected fat will not survive, and the
known physiological response to necrosis of this
tissue is scarring and calcification. As a result, detection of early breast carcinoma through xerography and mammography will become difficult and
the presence of diseasemay go undiscovered.”7
These opinions, unsupported by any references or
studies, made the injection of fat into a human
breast taboo and tantamount to malpractice.
Ironically also in 1987, a retrospective study of
the mammographic changes after breast
reduction8 reported that calcifications were detectable in 50 percent of all mammograms more
than 2 years from the time of surgery. Despite...