Lipofilling or structural fat grafting (SFG)
Lipofilling or structural fat grafting is a technique that is commonly used in aesthetic and reconstructive surgery to add volume to the subcutaneous fat layer. Despite the widespread use, the exact molecular mechanisms are not fully understood. This explains why different surgeons and research groups use different techniques and report different outcomes. What we know now is:
- after surgical lipofilling we generally observe a loss of 50% of the injected volume
- to reach significant volume restoration or gain, often multiple surgical sessions are necessary
- this means that it will take quite some time to build a significant volume as a minimum delay 3 months in between surgical sessions is required
- you need to dispose of sufficient donor fat (mostly love handles, abdomen, hips and thigh)
- there needs to be sufficient space at recipient site: high skin tension, scarring and compression can lead to poor results
- good oncological follow-up is recommended. Oil cysts, sometimes seen after this technique, are benign and can be removed by aspiration.
- Lipofilling only provides volume and does not generate skin, that is often required to generate aesthetically pleasing results in breast reconstruction.
Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety.
This survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.