Injectable fat grafting continues to expand in number of uses and in acceptance as a reliable method of adding volume. Once reserved for just small volume additions to the face, it has become more recently popular in breast surgery. Starting initially with its use in breast reconstruction, for lumpectomy defects and as touch-ups after more complete mastectomy reconstructions, it is expanding into elective cosmetic breast augmentation.
Breast augmentation with injectable fat is not yet as reliable nor as successful as the use of conventional synthetic implants. But the appeal for a natural method of breast augmentation is alluring to many patients. The fear of a having a lifelong implant in place and of ending up ‘too big’ is a stimulus for some to inquire about this option.
But despite that fact that putting one’s own fat into the breast is natural, or even organic, it is not without its own set of risks and complications. By far, the greatest risk is fat absorption and loss of any desired volume. A second risk is that of areas of fat necrosis may develop which will be felt or even seen as lumps or irregularities of the augmented breast.
The most significant risk, which is similar to that of breast implants, is infection. Because the fat is non-vascularized and has a significant volume, it is possible that infection may develop. The injected fat could become inoculated during the harvest, during its subsequent handling and processing, or from skin bacteria from the multiple entry sites for injection.
In a recent 2010 issue of Aesthetic Plastic Surgery, a group of Korean physicians report on their experience in fat grafting for breast reconstruction and cosmetic augmentation. In their series, they experienced a single case of multiple breast abscesses after injectable fat breast augmentation.
The case is described as follows. A 42-year-old woman came into the emergency room one week after breast augmentation with her own fat. The breasts had become increasingly tender, swollen, and warm. Infection was obvious and the question was whether this was cellulitis vs. frank abscess formation. Because of the more liquid nature of the fat, she was taken to the operating room for drainage. Drainage was immediately done under general anesgthesia where copious amounts of pus was drained from each breast. One could assume that the entire volume of fat injected was completely infected. She required IV antibiotics and betadine and saline irrigations through her open drainage incisions for two weeks. The authors report that at 9 months after her infection, her breasts looked reasonably normal with minimal scarring.
What this infection after breast fat grafting illustrates is that it is a potentially bigger deal and more serious than in an implant infection. An implant can be quickly and easily removed if infected and a quicker resolution is probably gotten. Because fat injections disperse the graft throughout the breast tissue, it may be harder and more prolonged to get a resolution to the infection. Of particular note, infection is the most serious complication from this procedure because the volume of the fat injected is large and can ultimately distort the contours of the breast due to fibrosis after it is resolved.
Patients for injectable fat breast augmentation need to be aware of this likely rare but possible postoperative complication. Serious infections like this one will occur fairly quickly within weeks after the surgery.
Dr. Barry Eppley
Indianapolis Indiana