부산대학교 도서관

PURPOSE:: Fat necrosis is a well-recognized complication following autologous fat grafting. The purpose of this study is to evaluate the incidence of fat necrosis after large volume fat grafting (LVFG) and identify risk factors for fat necrosis. METHODS:: A retrospective review was performed on 83 consecutive patients who underwent LVFG (>100ccs) to the breast performed by the senior author between September 2011-May 2016. Fat necrosis was defined as palpable nodules or nodules seen on imaging. RESULTS:: A total of 148 breasts underwent 170 autologous fat transplantations. Indications included: 72 reconstructions after surgical therapy and 98 cosmetic augmentations. Mean age was 48 years, median graft volume of 300ccs and median length of follow-up 423 days. Overall incidence of necrosis was 32.9%, with 47.8% in previously irradiated patients. Increased incidence of necrosis was associated with increasing fat graft volumes(p=0.032, OR=1.002), increasing BMI(p=0.04, OR=1.13), and simultaneous implant exchange with fat(p=0.003). Fat grafting volumes greater than 450ccs in a single breast was also associated with an increase in fat necrosis(p=0.04). Within a group of six patients that had bilateral fat grafting with unilateral radiation, there was a significant increase in necrosis on the radiated side(p=0.015). In a cohort of non-BRAVA patients, reconstruction (compared to augmentation) was associated with fat necrosis(p=0.039). CONCLUSION:: Increased rates of fat necrosis were associated with volumes greater than 450ccs, patients undergoing concurrent implant exchange with fat grafting, and fat grafting after a history of lumpectomy or mastectomy without preexpansion. Additionally, radiation may be associated with a higher rate of complications.