Pittsburgh, Pa.; Edmonton, Alberta, Canada; and Yokohama and Tokyo, Japan From the Division of Plastic Surgery, Department of Surgery, and Department of Radiology, University of Pittsburgh; Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton; Cellport Clinic Yokohama; Department of Plastic Surgery, Teikyo University School of Medicine; Department of Plastic Surgery, Kyorin University School of Medicine; and Department of Plastic Surgery, University of Tokyo School of Medicine.
Plast Reconstr Surg. 2012 May;129(5):1029-1038. doi: 10.1097/PRS.0b013e31824a2a8e.
: One issue in the adoption of autologous fat transfer to the breast is concern over mammographic changes that may obscure cancer detection. The authors compared mammographic changes following fat grafting to the breast with changes seen after breast reduction.
: Twenty-seven women who had normal preoperative mammograms were treated with fat grafting to the breast, including admixing of autologous adipose stem cells with the fat graft, for cosmetic augmentation. Repeated mammograms were performed 12 months after surgery. As a control group, postsurgical mammograms from 23 reduction mammaplasty patients were compared. Eight academic breast imaging radiologists reviewed each mammogram in a blinded fashion. Outcomes analysis accounting for individual radiologist's tendencies was performed using generalized estimating equations.
: The average volume of fat injected per patient was 526.5 cc. Fifty mammograms (27 lipotransfer, 23 breast reduction) were assessed. Differences in interpretation among individual radiologists were consistently observed (p < 0.10). Differences in abnormality rates were nonsignificant for oil cysts, benign calcifications, and calcifications warranting biopsy. Scarring (p < 0.001) and masses requiring biopsy (p < 0.001) were more common in the reduction cohort. Breast Imaging Reporting and Data System scores were higher after breast reduction (p < 0.001). Significant differences in the recommended follow-up time were also seen (p < 0.01).
: Compared with reduction mammaplasty, a widely accepted procedure, fat grafting to the breast produces fewer radiographic abnormalities with a more favorable Breast Imaging Reporting and Data System score and less aggressive follow-up recommendations by breast radiologists.
CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, III.
自体脂肪移植到乳房后，一个问题是担心可能会掩盖癌症检测的乳房 X 光变化。作者比较了脂肪移植后乳房的乳房 X 光变化与乳房缩小手术后的变化。
27 名术前乳房 X 光检查正常的女性接受了乳房脂肪移植治疗，包括将自体脂肪干细胞与脂肪移植混合，用于美容增强。术后 12 个月重复进行乳房 X 光检查。作为对照组，比较了 23 例乳房缩小整形术后的术后乳房 X 光检查。8 位学术乳房成像放射科医生以盲法方式审查每一张乳房 X 光片。使用广义估计方程进行考虑个别放射科医生倾向的结果分析。
每位患者平均注射脂肪量为 526.5cc。评估了 50 张乳房 X 光片（27 例脂肪转移，23 例乳房缩小）。个别放射科医生之间的解释差异始终存在（p<0.10）。在油囊肿、良性钙化和需要活检的钙化方面，差异无统计学意义。在缩小队列中，疤痕（p<0.001）和需要活检的肿块（p<0.001）更为常见。乳房成像报告和数据系统评分在乳房缩小后更高（p<0.001）。推荐的随访时间也有显著差异（p<0.01）。
与广泛接受的乳房缩小整形术相比，脂肪移植到乳房后产生的放射异常较少，乳房成像报告和数据系统评分更有利，乳房放射科医生的随访建议也不那么激进。
临床问题/证据水平：治疗，III。
