'Not All Fat Grafting Is the Same'—Different Techniques for Different Uses

Arlington Heights, Ill. - As fat grafting becomes incorporated into clinical practice, plastic surgeons propose a new approach to classifying these emerging techniques-emphasizing the need to match the right technique to the right clinical situation, reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Not all fat grafting is the same," write ASPS Member Surgeons Daniel Del Vecchio, MD, Boston, and Rod Rohrich, MD, of University of Texas Southwestern Medical Center, Dallas. "Fat grafting, once thought to be a simple technique with variable results, is a much more complex procedure with at least four definable subtypes."

In Fat Grafting, 'Different Problems Require Different Solutions'
Renewed interest in techniques using the patient's own fat for cosmetic and reconstructive plastic surgery has been noted in recent years. In these procedures, fat harvested from one part of the body is transferred to other areas-for example, fat obtained from the thighs using liposuction has been used for breast augmentation and reshaping.

That may sound fairly simple, but in recent years, fat grafting has "exploded into a complex menu of clinical choices." Plastic surgeons have reported "impressive clinical outcomes" using a wide range of different techniques and additives. The result is "a confusing picture as to which fat grafting technique is best," Drs. Del Vecchio and Rohrich write.

To clarify this situation, the authors propose a classification of clinical fat grafting techniques. Their classification seeks to match the technique to the individual patient's situation, based on four factors:
• Method of fat harvesting
• Method of cell processing
• Method of fat transplantation
• Management of the recipient site

For example, they present illustrative cases where smaller volumes of fat were needed to restore loss of fatty tissue in the facial area and reconstructive surgery on a chronic leg wound. In these patients, small amounts of fat were manually harvested from the abdomen using a small syringe.

In contrast, for patients undergoing cosmetic breast augmentation or breast reconstruction after mastectomy, larger amounts of fat were needed. In these cases, fat was harvested from liposuction of the thighs. In these situations, some form of "pre-expansion" of the recipient site in the breast was needed to make room for the larger volume of fat.

Different techniques were also warranted depending on the state of the tissue in the recipient area-for example, inflammation in the chronic leg wound and tissue damage caused by radiation at the mastectomy site. These and other factors may affect the technique used to process fat after harvesting. The most important issues related to fat survival after transplantation may also vary across different clinical situations.

While fat grafting-sometimes called fat transfer or transplantation-is not a new procedure, its development has not been straightforward. At one time, the ASPS opposed the use of fat grafting in the breast, citing possible problems in early detection of breast cancer. More recently, several studies in Plastic and Reconstructive Surgery have reported good results with various fat grafting procedures in a wide range of clinical situations.

Drs. Del Vecchio and Rohrich hope their classification system will provide a useful starting point to maximize the "vast reconstructive and cosmetic potential" of clinical fat grafting. They conclude, "As the true physiology of un-manipulated and stem cell-enriched fat grafts become better delineated, our choices for technical solutions will better fit the clinical problems we face."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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