BACKGROUND: Palpable lumps as sequelae of fat necrosis after fat grafting to the breast may not only cause physical or psychological symptoms to patients but also potentially complicate breast cancer screening. In this article, the authors present their experience in management of fat necrosis following fat grafting for breast augmentation. METHODS: Over a 5-year period, a total of 685 Asian women (age range, 20 to 58 years) underwent autologous fat transplantation to the breasts. The average volume of fat graft to each breast was 205 ± 45 cc. The preoperative and postoperative photographs and the breast volume were recorded. Detection of fat necrosis was based on clinical examinations and imaging studies. The mean follow-up was 208 ± 36 days. RESULTS: The mean volume increase was 135 ± 20 cc in a single breast, with a mean graft retention rate of 65 percent. Sixty-six patients (9.6 percent) were found to have fat necrosis in the form of solitary or multiple cysts, sclerotic nodules, or calcifications in either one or both breasts postoperatively. The average time before first detection of the breast lump was 108 ± 45 days. Management of fat necrosis included aspiration or excision based on the authors' treatment algorithm. The symptoms related to fat necrosis such as discomfort on palpation, pain, or possible skin reaction were significantly improved in 54 of 57 patients (94.7 percent). CONCLUSIONS: Fat necrosis following autologous fat grafting for breast augmentation can be managed successfully and its related symptoms can be relieved in 94.7 percent of patients. It can be approached safely based on a sound algorithm developed by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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