Commentary

The review presented by Mizuno and Hyakusoku discusses the interesting clinical history of fat grafting to the breast, as well as the physiology and basic science concepts behind its application and results. The authors note that the first known fat transfer was completed by Neuber in 1893, where fat grafts from the arm were transplanted to fill facial soft tissue defects following tuberculosis.1 Two years later, Czerny first described fat transfer to surgically correct a breast deformity resulting from operative intervention on chronic cystic mastitis.2 Significant postoperative resorption and minimal graft survival was reported in 1950, leading to the subsequent decline of autologous fat transfers in the face and breast.3 Refined techniques and improved outcomes, however, renewed interest in fat transfer in the 1980s in the field of facial reconstruction.4 In contrast, fat grafting remained unpopular in clinical use for breast reconstruction, particularly when the American Society of Plastic and Reconstructive Surgeons (ASPRS) Ad-Hoc Committee on New Procedures released the statement in 1987 that the committee “unanimously deplored the use of fat injection in breast augmentation.”5 Despite this statement, techniques improved with research using low negative-pressure syringes to minimize cellular trauma and centrifugation to separate out adipocytes.6,7 In 2007, the ASPRS and the American Society for Aesthetic Plastic Surgery (ASAPS) relaxed their positions and recommended caution against fat injection in the breast but jointly encouraged research efforts to improve “the safety and efficacy of the procedure.”5,8 Along with this national support, the authors point out a significant increase in the number of articles published on this topic since then. Promising results in clinical level III and IV data studies exist, but these procedures are extremely surgeon dependent and may have prolonged operative times.