Large-volume breast fat transfer: technical evolutions and safety aspects based on over 800 cases and 26 years of follow-up

Current techniques for augmentation mammoplasty involve the use of alloplastic materials and an open approach. The former may not be well tolerated and often can be the origin of undesirable effects such as capsule contracture. The latter implies residual scars, which can sometimes be less than satisfactory from an esthetic point of view. Considering all the problems mentioned above and seeking to find safe and reliable alternatives to implants, we focused our attention on the possibility of using fat tissue as filling material for breast augmentation. Autologous adipose tissue has been used to correct soft tissue defects for more than a century. Its soft and natural texture, the absence of a line, and its versatility have always made adipose tissue the ideal physiologic filling material. The author describes his surgical experience with breast fat transfer. The clinical outcome described in this Article is based on over 800 patients with a follow-up period of over than 26 years. The surgical techniques described by the author evolved constantly and steadily aiming to achieve more consistent results and trying to increase at the same time patient safety and satisfaction. Analyzing the clinical data clearly appears that complications are strictly related to the oily content of the transplanted tissue, where more TGs in the recipient site is clearly at the origin of a higher level of complications. In order to improve patient’s safety and to limit risk of side effects, the author developed a new “oil-free” fat transfer technique. All the technical steps are described in details. An important part of this work is dedicated to a careful evaluation of safety aspects and oncologic concerns. The total oncologic safety of fat transfer in breast reconstruction and in esthetic augmentation has been clearly proved and confirmed.

Level of Evidence: Level IV, therapeutic study.