A Comparison of Fat Graft Processing Techniques

Outcomes in 1,158 Procedures in Prosthetic Breast Reconstructions

Wen-Kuan Chiu, MD; Megan Fracol, MD; Lauren N. Feld, BS; Cecil S. Qiu, BA, MD; John Y.S. Kim, MD, FACS


Plast Reconstr Surg Glob Open. 2019;7(11):e2276 

In This Article

Abstract and Introduction


Background: As fat grafting in breast reconstruction evolves, questions of technique and outcomes persist. We compared 2 common fat processing techniques—decantation (DEC) versus closed wash and filtration (CWF)—with regard to outcomes and efficacy.

Methods: Chart review of a single surgeon experience with breast fat grafting was performed. Data extracted included demographics, technique, complications, graft volume, and revision rates. Secondarily, the timeline of complication profiles was analyzed. Lastly, subgroup analysis of radiated versus nonradiated breast outcomes was performed.

Results: One thousand one hundred fifty-eight fat grafting procedures were performed on 775 breasts (654 DEC, 504 CWF). Time-to-event analysis for all complications showed no difference between groups. Independent risk factors for fat necrosis included DEC technique, body mass index >30 kg/m2, and fat injection >75 mL. The majority of cases of fat necrosis, cyst/nodule formation, ultrasounds, and biopsies occurred more than 6 months after grafting. Average graft volume was lower in DEC compared with CWF breasts (50.6 versus 105.0 mL, P < 0.01), and more DEC breasts required repeat fat grafting procedures (39.9% versus 29.6%, P < 0.01). Radiated breasts received larger fat graft volume (89.9 versus 72.4 mL, P < 0.01) and required more fat graft procedures (average 1.62 versus 1.47, P < 0.01).

Conclusions: This study represents the largest series of breast reconstruction fat grafting to date. DEC harvest technique may be a risk factor for fat necrosis, which results in less fat injection and greater need for repeat procedures. Similarly, radiated breasts require larger graft volume and more repeat procedures.


Autologous fat grafting (AFG) is a widely accepted technique for improving esthetic outcomes through volume enhancement and correction of contour deformities following breast reconstruction surgery.[1–3] It provides the ability to shape and contour tissue through a minimally invasive approach and is associated with high patient satisfaction in numerous studies and systematic reviews.[1,4–7] AFG includes 4 steps: recipient site preparation, fat harvesting, processing, and injection. Fat processing is not a mandatory step of fat grafting; however, many surgeons process the harvested fat with the goal of purifying adipocytes to remove unwanted debris that could potentially affect cell viability.[8] Although previous studies have shown AFG to be a safe and effective technique to improve esthetic outcomes in breast reconstruction, the optimal fat processing technique remains elusive due to inconclusive evidence regarding relative efficacy.[9–15] Moreover, there is a paucity of data on longer-term nononcologic outcomes of fat grafting with respect to surgical complications and need for revision fat grafting.

Two commonly used methods of fat processing by the senior author include decantation (DEC), in which manually harvested fat is collected into a syringe and allowed to settle into separate layers, and closed wash and filtration (CWF), in which lipoaspirate is washed with saline and filtered with suction assistance. Although histologic studies have suggested advantages to CWF in terms of decreased cellular debris and greater fat retention, no studies have directly compared the risk of potential sequelae of fat impurities, such as oil cysts and fat necrosis, between these 2 techniques.[16,17]

Accordingly, this study's primary purpose is to compare these 2 common methods of fat harvest with respect to complications and efficacy. Second, we endeavor to provide the first granular detail on timelines of complications and risk factors for complications to better address surveillance issues following fat grafting. Third, we performed comparative subgroup analysis of radiated versus nonradiated breasts undergoing fat grafting.