Fat-transfer breast augmentation: What percentage survives? Understanding graft survival rates

The first concern everyone has is "how much of the injected fat will remain?" While answers vary, the variation itself has meaning. Understanding what determines the survival rate will change how you view your surgical options.

Since transplanted fat survives only after gaining blood supply, it has greater absorption than artificial materials and is considered difficult to predict[2]. The textbook absorption rate is25–80%and a wide range of[1]、this "large width" is the essence of fat grafting. In quantitative data, a systematic review by Seth et al. (820 breasts) showed that an average injection of293ccresulted in an average retention after one year of58.6%is reported[3]. It becomes more realistic to consider that slightly more than half remains as a rough guideline.

Three factors that determine retention

First is weight change. In a prospective 3-year study by Ørholt et al. using MRI, it was demonstrated that long-term retention volume is greatly influenced by weight gain or loss[5]。If you lose weight after the procedure, the transferred fat will also decrease. Second is the blood flow of the recipient site. Khouri et al. explained that in cases of conversion to a deflated breast, retention was only 64%, whereas a breast that was pre-expanded and well-vascularized was more suitable for graft survival[6]。Third, the ratio of injection volume to the recipient site. In the same study by Ørholt et al., even when the ratio of injection volume to the recipient site was increased to 2:1, a plateau in the augmentation rate was not observed[5]。This is why overcorrection (injecting more) and pre-expansion with Brava make sense.

Strategies to increase numbers and their limitations

Ancillary techniques improve retention rates. In Seth et al.'s review, with Brava pre-expansion,64.1%, with SVF combination,66.5%, with PRP combination,71.8%, and with stem cells (ADSC) combination,80.2%and was reported.[3]However, it is dangerous to choose based on numbers alone. While the journal Aesthetic Plastic Surgery reports a significant additive benefit of stem cell combination therapy,[3]the Japanese Society of Plastic Surgeons' guidelines clearly state with caution that "no high-evidence reports have been obtained," and[4]assessments differ between academic societies. As a complication, calcification occurs.15.8%・Fat necrosis11.3%have been reported, but both are benign.[3]Returning to the comparison with silicone mentioned in Episode 1, fat injection is a choice in which you accept the uncertainty of resorption in exchange for the peace of mind that comes with using your own tissue. How much to employ adjunctive techniques will be determined together during your consultation by comparing your expectations against the strength of the evidence.