Harvesting site complications. The scars are to be placed in a discreet area, generally within a skin fold, or in the peri-umbilical area. So far, there has been no complaint as to a inaesthetic scar. Most patients are satisfied with the removal of the excessive fat, which is the secondary benefit that probably contributes most to the high overall satisfaction rate of this procedure.
A local infection has been reported in one case (in 3000 procedures performed from 1998 to 2017), which manifested itself by peri umbilical redness, and was successfully treated by antibiotherapy and ice applied locally.
Transfer site complications (breast). The scars are to be placed in the inframammary fold, the axillary prolongation of the breast or in the nipple area, where the scars are always of good quality. The pre-sternal area is to be avoided, as it poses a greater risk of hypertrophic scarring. The incisions are made by a needle, and are therefore usually invisible due to their 1.5 mm diameter. As for reconstructive surgery, the scars of the previous mastectomy or tumorectomy are reused. 13 infections have been registered at the level of the breast (13/3000 surgeries), having manifested themselves as redness. After removal of the corresponding suture oily fat has expressed itself; antibiotherapy and local care have permitted complete resolution of these phenomena, without any sequelae.
Another thing worth mentioning is that we have experienced one perioperative pneumothorax (1/3000 interventions lead by me) and 2/6000 interventions carried out by my team during the same perod. These were probably due to a pleural penetration by the injection cannula. A perioperative desaturation has been observed and after the diagnosis of a pneumothorax, we have drained the air in the pleural cavity which has brought about a normalisation of the saturation and a restitution ad integrum.
To avoid this complication, the projection area around the areola should be injected via 2 inframammary fold incisions, not the peri areolar incision. We have not experienced any further pneumothorax cases since the application of this principle.
We have never experienced fat embolism, which is a result of injecting fat into a large vessel. With respect to this, the greatest care is to be taken in the sub clavicular area; notably in cases of thoraco-mammary malformations within Poland syndrome, where the vessels may be lower positioned than usually.
In 10% of cases oily cysts may occur. These appear as a well-rounded tumefaction, just underneath the skin, that can be easily treated by a puncture with a pink needle (call your surgeon directly, in order to schedule an appointment).
In 3% of all patients, we have encountered clinical foci of solid fat-necrosis. This finding is more frequent in less experienced surgeons (less than 50 surgeries) at about 15%. Generally, the solid fat-necrosis developed in patients who had undergone lipomodelling in breasts reconstructed by the abdominal flaps. In these cases, there were areas in which the tissues had been “forced” or the receiving tissue did not permit a more important fat transfer. When the receiving tissue is saturated in fat, insisting on injecting any further quantity will result in cytosteatonecrosis. These areas of fat-necrosis are typical: slightly sensitive and slowly evolving towards a diminution in size with the passage of time. However, if an augmentation in volume is observed, one must consider an oncologic cause within the differential diagnosis. Any dure tumefaction of the breast (even if reconstructed) is subject to a microbiopsy by an experienced radiologist, in order to exclude neoplasia.