Fat grafting to the breast & Mammograms

Currently, one of the big controversies in Plastic Surgery is the topic of fat grafting to the breast, either for post-cancer reconstruction or cosmetic purposes. For years, there have been concerns about the changes that can occur if the injected fat doesn't take in the new location, creating scar tissue. The worry is, of course, that the lump of scar tissue in the breast can look and feel like a breast cancer. Certain scar tissue patterns, on a mammogram, can look just like a breast cancer, and require a biopsy to sort out.

So, any science (rare) as opposed to opinion (frequent) on this topic is welcome news.

At the recent IFATS meeting in Dallas, Dr. Peter Rubin and his team from the University of Pittsburgh presented an interesting review of mammograms following fat grafting to the breast versus mammograms after a standard breast reduction.

They looked at one of the most well-documented series of fat grafting patients, those of Dr. Yoshimura in Japan, who performed breast enhancement with fat grafts which were "turbo-charged" with additional stem cells from the Cytori Celution 800 machine. These 27 patients all had pre-op and 1 year post-op mammograms. These 27 were matched with one year post-surgical mammograms from 23 age-matched women who had undergoing breast reduction surgery.

Then, 8 University of Pittsburgh radiologists with experience in mammography
reviewed each of the 50 post-surgical mammograms without knowing the procedure that had been previously performed, and their comments were tabulated.

Results: Differences in abnormality rates were about the same between the two groups for the findings of oil cysts, benign calcifications and calcifications warranting a biopsy. Scarring and masses requiring biopsy were actually more common in the breast reduction group.

Based on this review, Dr. Rubin, who is a well-respected plastic surgeon and stem-cell researcher, felt that lipoaugmentation of the breast, when performed with Dr. Yoshimura's specific method, had mammographic results that were equal or better than the results after reduction mammaplasty, which is a well-accepted procedure.

Currently, Cytori is still waiting for FDA approval of their Cellution machine. Only surgeons who are using this machine can duplicate Dr. Yoshimura's technique. For all the other methods of fat grafting out there, questions about mammography still remain unanswered.