Autologous Fat Grafting to the Breast: An Educational Review

Immediate Oncoplastic Breast Reconstruction with Fat Grafting: Preliminary Radiological, Aesthetic, and Patient Satisfaction Outcomes

INTRODUCTION

Fat grafting is a valuable tool for oncologic breast reconstruction, as it enhances aesthetic outcomes. However, concerns regarding oncologic safety and challenges in postoperative imaging have limited the adoption of immediate oncoplastic breast reconstruction (IOBR) with fat grafting. This approach can reduce the need for additional surgeries, shorten recovery time, improve aesthetics, and help mitigate the adverse effects of adjuvant radiation therapy. This study evaluates postoperative, radiological, aesthetic, and patient-reported outcomes of immediate fat grafting in oncoplastic breast reconstruction following lumpectomy.

METHODS

We conducted a retrospective study of patients undergoing IOBR with immediate fat grafting following lumpectomy (2020-2022). The plastic surgery team performed reconstruction simultaneously with lumpectomy by breast surgeons. Patient satisfaction was assessed using the Breast-Q questionnaire, while expert surgeons evaluated aesthetic outcomes. Lesion characteristics, specimen weight, and postoperative radiation details were recorded. Postoperative breast imaging was reviewed for fat grafting-related abnormalities.

RESULTS

Fifteen patients were included, with 87% undergoing postoperative radiotherapy. No major complications or readmissions occurred within 30 days. Breast imaging follow-up showed 91.1% had benign post-surgical changes, while 8.9% required short-term radiologic follow-up. Post-lipoid injection findings appeared in 37.8% of cases, none with calcifications. Patient satisfaction was high (average Breast-Q Score was 74.5), with only one patient requesting additional fat grafting post-radiation. Expert assessments confirmed improved aesthetic outcomes.

CONCLUSION

IOBR with immediate fat grafting is a useful technique for lumpectomy defects across all breast quadrants, demonstrating low complication rates, high patient satisfaction, and positive aesthetic outcomes. Postoperative imaging follow-up revealed no adverse effects related to fat grafting, supporting its potential role as an additional tool in oncoplastic breast reconstruction.

LEVEL OF EVIDENCE IV

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Acellular Dermal Matrix: Imaging Features With Histopathology Correlation

Acellular dermal matrix (ADM) is an immunologically inert graft, typically from cadaveric skin, often used in postmastectomy breast reconstruction. Created from decellularized dermal tissues that have been treated to remove DNA and antigenic donor cells (leaving extracellular matrix), ADM is often used as a structural scaffold or sling to reinforce and support the structure and position of a breast implant during postoperative integration in implant-based breast reconstruction; ADM can also be used to fill cosmetic defects. Advantages of ADM use include improved cosmesis and reduced capsular contracture rates. On US, ADM can be seen as a subtle band with variable echogenicity adjacent to the implant. When folded on itself or redundant, ADM may present as a palpable oval mass with indistinct or circumscribed margins and variable echogenicity. On mammography, ADM can be seen as a circumscribed oval equal density mass when redundant and folded on itself; a layered appearance may be evident on tomosynthesis. On MRI, presence and absence of enhancement have been documented. Imaging findings likely vary depending on the degree of host tissue remodeling and incorporation, and when biopsied, histopathologically, ADM may be difficult to distinguish from scarring. Successful imaging diagnosis of ADM is aided by clinical knowledge of the intraoperative use and configuration of ADM, which may help differentiate ADM from new or recurrent malignancy and avoid unnecessary biopsy.

The Postoperative Breast: Imaging Findings and Diagnostic Pitfalls After Breast-Conserving Surgery and Oncoplastic Breast Surgery

Breast surgery is the cornerstone of treatment for early breast cancer. Historically, mastectomy and conventional breast-conserving surgery (BCS) were the main surgical techniques for treatment. Now, oncoplastic breast surgery (OBS), introduced in the 1990s, allows for a combination of BCS and reconstructive surgery to excise the cancer while preserving or enhancing the contour of the breast, leading to improved aesthetic results. Although imaging after conventional lumpectomy demonstrates typical postsurgical changes with known evolution patterns over time, OBS procedures show postsurgical changes/fat necrosis in locations other than the lumpectomy site. The purpose of this article is to familiarize radiologists with various types of surgical techniques for removal of breast cancer and to distinguish benign postoperative imaging findings from suspicious findings that warrant further work-up.

Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know

Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited.

The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy.

Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence).

In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.