Abstract
Reporting of complications such as infection, necrosis, oil cysts and haematoma after fat transfer varies widely in the literature. Numerous variations in techniques (for example, cannula size, infiltration solution and fat-processing methods) have been described across a heterogeneous patient population for age, fat harvest location and recipient site. To date, no comprehensive review of the literature has been performed for all fat transfer procedures across the body. This study aims to provide novel information on the incidence of complications after fat transfer and is unique in its size and scope.
A systematic review of English literature was performed from 01/01/08 to 01/09/24 in MEDLINE, EMBASE, PUBMED and Cochrane Database of Systematic Reviews. Measured complication outcomes included necrosis, infection, induration, oil cysts, haematoma and pneumothorax. A random-effects model was employed to calculate the pooled complication incidence from selected articles.
After application of inclusion and exclusion criteria, 42 articles progressed to final analysis with a total of 6268 patients. Major complications investigated were fat necrosis (n=44, 0.7%), infection (n=66, 1%), induration and calcification (n=40, 0.6%), oil cysts (n=7, 0.1%) and haematoma (n=4, 0.06%). Pneumothorax post-procedure incidence was 0.1% (n=6). Overall complication incidence was 4.2%.
This study is unique in its scope and size and can be used for counselling patients in the pre-operative setting, providing a benchmark for surgeons to assess their practice with an overall complication incidence of 4.2%.
Introduction And Background
First described by Neuber G [1] in 1893, fat transfer, or autologous fat grafting, has been used in a variety of applications, including correcting breast contour defects after cancer surgery and lower limb defects after major trauma. Fat transfer is common, constituting 5.9% of all surgical aesthetic procedures, with more than 514,000 procedures performed globally in 2009 [2,3]. Over 70% of plastic surgeons use fat transfer to reconstruct breast defects [2,3]. Various techniques of fat harvest and transfer have been described, the most common of which is the Coleman fat grafting technique [3].
Ideal areas for fat harvest have yet to be defined [4]; a donor site is usually the anterior abdominal wall or thigh. Harvesting involves the aspiration of a fat solution from a given donor site through a metal cannula. The aspirate contains both adipocytes and adipocyte-derived stem cells, which increase regenerative potential and vascularisation of the graft [5-7].
Introduction of too much fat can lead to increased interstitial pressure and a collapse of capillaries, leading to hypoxia and graft loss [3,8,9]. However, the success of fat graft take is highly variable. A systematic review of 16 clinical studies revealed that fat survival can be as little as 15% from six months to 3.7 years of follow up [10].
Factors affecting complications after fat transfer are poorly described in the literature. Early complications (<4 weeks from the time of procedure) may include local surgical site infection (0.7% donor or recipient site not requiring surgery [11]) and major complications such as pulmonary embolism. Major complications needing surgical intervention or hospitalisation have been described in a limited manner (incidence of ~6% in breast patients [11]), with the incidence of infections requiring surgery in breast patients being 2% [11]. Late complications (>4 weeks from procedure) may include graft necrosis, resorption and calcification [12]. Low-morbidity complications are the most numerous at 60% (such as swelling and induration) after breast fat transfer [12]. The incidence of fat necrosis ranges from 3% to 17% [13-16] and is hypothesised to be influenced by high fat-transfer volume [14] and operative technique.
By pooling the complications of worldwide studies, the incidence of specific complications can be elucidated for a variety of techniques. To date, no comprehensive review of the literature has been performed for all fat transfer procedures across the body. This study aims to provide novel information on the incidence of complications after fat transfer and is unique in its size and scope, and will thus provide a benchmark for patient outcomes in surgical practice.
Review
Methods
Data Sources
A systematic review of literature in English was performed using the following databases: MEDLINE, EMBASE, PUBMED, Cochrane Database of Systematic Reviews. The following keywords were used: [(Autologous fat grafting) OR (autologous fat transfer)] AND (complications). The publication date range was 01/01/2008-01/09/2024 to include more recent literature and practice.
Study Selection
Each article was independently reviewed by two researchers (JAB and HC) for review. Eligibility criteria were defined using the population, intervention, comparator, outcome and study design approach (PICOS) [17]. Inclusion and exclusion criteria are summarised in Table 1. A subgroup of articles was included in a given paper if the data could be extracted and satisfied the inclusion and exclusion criteria.
