Thursday, August 13, 2009

ASPS Task Force Updates Position on Fat Grafting

I have written about fat grafting to the breast previously here and here. 

The Fat Graft Task Force of the American Society of Plastic Surgeons (ASPS) convened to try to answer the question of whether fat grafting compromises breast cancer detection and/or results in potentially catastrophic sequelae in patients?  Their conclusion:  there is no indication that fat grafting is an unsafe procedure with qualifications that more research is needed.

Sydney R Coleman, MD is quoted in the Cosmetic Surgery Times article, "In review of the multitude of evidence-based results of clinical trials, case series and reports, the Task Force found that there is no evidence that indicates that fat grafting is an unsafe procedure.  Nevertheless, the report did say that in order for the Task Force to make concrete recommendations for or against fat grafting for specific applications, high-quality randomized controlled trials would be needed to further evaluate safety and efficacy."

The following conclusions are from the February 2009 Task Force Report:

CONCLUSIONS
Clinical Applications
Based on a review of the current literature and a lack of strong data, the Task Force cannot make specific recommendations for the clinical use of fat grafts. Although fat grafts may be considered for use in the breast and other sites, the specific techniques of graft harvesting, preparation, and injection are not standardized. The results therefore may vary depending on the surgeon’s technique and experience with the procedure. Although there are little data to provide evidence for long-term safety and efficacy of fat grafting, the reported complications suggest that there are associated risks. Regarding fat grafting to the breast, there are no reports suggesting an increased risk of malignancy associated with fat grafting. There is a potential risk of fat grafts interfering with breast physical examination or breast cancer detection; however, the limited data available suggests that fat grafts may not interfere with radiologic imaging in detecting breast cancer.


Future Research
The Task Force believes autologous fat grafting is a promising and clinically relevant research topic. The current fat grafting literature is limited primarily to case studies, leaving a tremendous need for high-quality clinical studies. While this evidence-based review resulted in few, if any, new data that would prompt a substantial change in the current state of fat grafting, the lack of new information poses two important questions: (1) are current methods of fat grafting still the "gold standard," or (2) is more research needed and should funding be directed toward new studies? For many aspects of fat grafting, the Task Force found the latter to be true and has
suggested the following areas for future research:

  • Randomized controlled trials to assess safety and efficacy of fat grafting for different indications
  • Randomized controlled trials to assess safety and efficacy of specific fat grafting techniques
  • Studies to further assess the effect of fat grafting on breast cancer detection and treatment.
  • Studies to identify risk factors and improve patient selection for procedures involving fat grafting.
  • Studies to investigate aspects of cell/tissue viability and graft survival, as well as long term storage and banking of fat grafts.
      

 

REFERENCES

ASPS' Fat Graft Task Force updates position on safety of autologous fat grafting; Cosmetic Surgery Times, Aug 1, 2009; Ilya Petrou, MD

Current Applications and Safety of Autologous Fat Grafts: A Report (pdf); American Society of Plastic Surgeons; Feb 2009

Fat Transfer/Fat Graft and Fat Injection:  ASPS Guiding Principles (pdf); January 2009

 

 

Related Posts

Fat Injections for Breast Augmentation (November 6, 2008)

Complications After Autologous Fat Injections to the Breast – an Article Review (April 2, 2009)

Recent NPR Stories on Plastic Surgery (June 3, 2009)

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