The Volumetric Analysis Of Percentage Volume Maintenance In Autologous Fat Grafting Breast Augmentation

BackgroundIn 2007, the American Society of Plastic Surgeons (ASPS) commissioned a Fat Graft Task Force that concluded that autologous fat transfer might be used for the breast, "while the techniques and the results vary, leaving a tremendous need for high quality clinical studies." As autologous fat transfer is gaining popularity, our ability, however, to judge the overall success of fat grafting remains limited. Recently, the term "percentage volume maintenance" has emerged as an important outcomes measurement in fat transplantation that can be used to compare results. Three-dimensional photography has been applied to quantify breast volume and shape and it has been shown to be a useful device to accurately quantify the volumetric changes during the postoperative period. We proposed a study to collect clinical outcome data of fat graft breast augmentation using three-dimensional photography technique.ObjectiveThe aims of this study were (1) to gather data of percentage volume maintenance after autologous fat grafting breast augmentation and analyze variables; (2) to perform a general linear regression to build the optimal model for development of a percentage volume maintenance predictive formula; (3) to compare percentage volume maintenance after the first and second fat graft session; (4) To obtain patient-reported outcome data after the first fat graft session and analyze its relevance to percentage volume maintenance.Methods1. We performed a retrospective review of all patients who underwent autologous fat graft breast augmentation in our center between March 2011 and December 2014. Thirty-nine patients were included. Calculated percentage volume maintenance using three dimensional photography techniques. Age, BMI, donor site, breast preoperative volume, whether apply Brava and water-jet-assisted liposuction are collected as variables. We performed multivariate regression and univariate regression in a general linear regression model and multilevel linear regression model to identify significant factors.2. A general linear regression was performed to build a predictive formula with the most important predictors emerged in the first part analysis.3. We calculated percentage volume maintenance after the first fat graft session and overall percentage volume maintenance after the second fat graft session using three-dimensional photography. We performed t test to compare the results.4. Patient reported outcome were obtained by Breast Q preoperative and postoperative breast augmentation module. Data of satisfaction with breast, psychosocial well-being, sexual well-being, physical well-being were compared with t test. Correlation between satisfaction with overall outcomes and percentage volume maintenance were analyzed with Pearson analysis.Results1. The mean age of the patients included was 31.38±7.19. The mean follow-up months were 4.10±1.77. The mean preoperative breast volume was 54±34.1 lml and mean fat graft volume was187.95 ±54.28ml. The mean percentage volume maintenance was 0.34±0.12. In univariate regression analysis, age, donor site, Brava were found to be significantly corresponded to changes in percentage volume maintenance. In the multivariate regression analysis, age is no longer significant (P=0.0808). However, there was still important impact clinically. Same conclusion was found in multilevel linear regression model.2. In the second part of the study, the mean percentage volume maintenance was 0.25±0.06, compared with overall mean percentage volume maintenance of 0.32 ±0.06 after the second session. There was significant difference between the results.3. In the third part of the study, there was significant improvement in the scores of satisfaction with breast, psychosocial well-being, sexual well-being postoperatively. There was no significant correlation between satisfaction with overall outcomes and percentage volume maintenance.Conclusion1. The mean percentage volume maintenance was 0.34±0.12 after the first session of fat graft breast augmentation. The age, Brava, and donor site were found to be significant impact factors to percentage volume maintenance.2. There was a significant improvement of percentage volume maintenance after the second fat graft session.3. For the patient reported outcome, there was significant improvement in the scores of satisfaction with breast, psychosocial well-being, sexual well-being postoperatively. There was no significant correlation between satisfaction with overall outcomes and percentage volume maintenance.