Breast Fat Injection Causes Confusion on Mammograms

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A breast augmentation procedure in which fat from other parts of the body is transferred to the breasts causes can cause false suspicion of breast cancer on follow-up mammograms , according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

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A breast augmentation procedure in which fat from other parts of the body is transferred to the breasts causes can cause false suspicion of breast cancer on follow-up mammograms, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The mammographic changes occurring after fat injection are indistinguishable from abnormalities associated with breast cancer, according to the study by Dr. Cong-Feng Wang of Meitan General Hospital, Beijing. Based on this "mammographic confusion," the authors conclude that the use of autologous fat injection for breast augmentation should be "prohibited continuously."

Microcalcifications Cause Confusion on Mammograms after Fat Injection
Dr. Wang and colleagues report on 48 women who underwent autologous fat injection for breast augmentation between 1999 and 2009. In this procedure, small amounts of fat obtained by liposuction from one area of the body (such as the hips or thighs) are injected to shape the breasts.

In the study, mammograms obtained some years after fat injection showed "clustered microcalcifications" in eight of the 48 women—a rate of 16.7 percent. In all eight cases, the microcalcifications were regarded as "highly suspicious" for breast cancer.

The abnormalities prompted surgical biopsy to remove and examine the breast area showing microcalcifications. None of the biopsies revealed breast cancer. Instead, the calcifications appeared to be related to death (necrosis) of the injected fat cells.

There is a long history of debate over the use of injected fat for breast augmentation. In the late 1980s, the ASPS issued a strong statement against the use of this procedure, citing the risk of difficulties in early diagnosis of breast cancer. However, more recent studies have reported that autologous fat injection provides very good results, and that any changes seen on mammograms are easily distinguished from abnormalities related to breast cancer.

In contrast, the new study finds mammographic abnormalities suspicious for breast cancer in 1 out of 6 women undergoing fat injection for breast augmentation. The clustered microcalcifications are indistinguishable from those associated with breast cancer, requiring biopsy to make the correct diagnosis. Because of this issue—and independent of the aesthetic results achieved—Dr. Wang and colleagues strongly believe the use of autologous fat injection for breast augmentation should be discontinued.

However, that recommendation conflicts with a paper published in the March issue of PRS, which concluded that "Radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure." The conflicting results highlight the need for caution—and for more scientific evidence on the mammographic changes occurring after fat injection.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS
The American Society of Plastic Surgeons (http://www.plasticsurgery.org/) is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Plastic and Reconstructive Surgery
For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

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Marie Grimaldi
American Society of Plastic Surgeons
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