I read with interest the searing clinical article on fat grafting to the breast in the April 2011 edition of the Journal of The American Society of Plastic and Reconstructive Surgery (PRS, for short…) authored by a group of Chinese plastic surgeons.
The abstract can be read here
The Chinese fat grafting article slams the practice of fat grafting to the breast. Wang, et al conclude that radiologists in their practice could not discern between calcifications on a ‘digitized’ mammogram that are a result of fat grafting to the breast, and calcifications that might represent breast cancer. The group recommended breast biopsy (a surgical procedure) in a number of these patients, with the result of ’fat necrosis’ (no surprise !), which is not breast cancer. At the end of their paper, they make the illogical conclusion that
‘ The mammographic confusion constitutes the problem rather than the success of the procedure itself, and the method should continue to be prohibited.’
This paper echoes the concerns raised several years ago regarding the managment of calcifications noted on mammography of patients that have had fat grafting to the breast. However, in recent years, digital mammography and contrast MRI have become much more accurate in descerning the difference between calcified bits of fat necrosis and malignant micro-calicifcations. In fact, numerous papers in the radiology literature have confirmed that calcified fat necrosis and malignant microcalcifications can be easily distinguished with modern digital mamographic equipment and experienced radiologist reviewing the images. Other clinical studies that have followed fat grafting patients long term note no increase incidence in breast malignancy in this patient population.
In my own practice of fat grafting to the breast, we obtain digital mammography on all patients pre and 6 months post fat grafting, and have encountered no concerning calcifications.
In summary, this recent retrospective review documents nothing more than a Chinese plastic surgical group’s aggressive management of what appear to be benign micro-calcifications. In contrast, fat grafting surgeons world-wide have been buyoed by the numerous recent publications in PRS and other journals that support the safety and efficacy of fat grafting to the breast. Every other surgical procedure done to the breast induces some fat necrosis and calcification that can show up on mammogram. Yet no one is calling for the ban on breast reduction, mastopexy or augmentation !
Fat grafting to the breast is yet another tool that plastic surgeons can begin to use to improve form and restore volume to the breast.
