by Knackstedt, Rebecca
W.; Gatherwright, James; Ataya, Dana; Duraes, Eliana F. R.; Schwarz, Graham S.
Background: Fat grafting is a powerful and increasingly used technique in breast
reconstruction. However, fat necrosis can lead to palpable postoperative
changes that can induce anxiety and lead to unplanned diagnostic studies. The
authors’ aim in this study was to evaluate the incidence, type, and timing of
these unanticipated studies; the specialty of the ordering provider; and the
factors that trigger the ordering process.
Methods: A retrospective chart review was conducted for patients from 2006 to
2015 who underwent fat grafting as part of implant-based breast cancer
reconstruction and had at least 1-year follow-up after fat grafting.
Results: From 2006 to 2015, 166 patients underwent fat grafting as part of
implant-based breast reconstruction. Forty-four women (26.5 percent) underwent
at least one imaging procedure. Thirteen women (7.8 percent) underwent 17
biopsies. For a palpable mass, the initial imaging test most commonly ordered
was ultrasound, followed by mammography/ultrasound. The percentage of patients
with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was
4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had
distant metastases. Tissue diagnosis of local recurrence was never identified.
Mean follow-up was 2.4 years.
Conclusions: Fat-grafting sequelae may lead to early
unplanned invasive and noninvasive procedures initiated by a variety of
providers. In this study, fat grafting had no impact on local recurrence rate.
As use of fat grafting grows, communication among breast cancer care providers
and enhanced patient and caregiver education will be increasingly important in
optimizing the multidisciplinary evaluation and monitoring of palpable breast
lesions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
