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Incidence and Impact of Unnecessary Diagnostic Studies Following Fat Grafting
Rebecca Knackstedt MD PhD, James Gatherwright MD, Graham Schwarz MD
Cleveland Clinic
2017-02-04
Presenter: Rebecca Knackstedt MD PhD
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Fat grafting is an oncologically safe and cosmetically effective reconstructive option. However, post-operative changes can induce anxiety in patients and caregivers that can lead to non-essential diagnostic studies. Our aim is to evaluate the incidence and factors leading to these unanticipated studies and determine how they can be avoided or minimized.
Methods
A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of breast cancer reconstruction and had at least one year follow-up from first fat grafting episode.
Results
331 patients underwent a mean of 1.6 unique fat grafting episodes (530 total episodes). There were 123 ultrasounds performed with the most common indication being confirmation of prior imaging, followed patient complaint or a "mass" on physical exam. Twenty-nine biopsies were performed on twenty-six patients. The most common indication was confirmation of imaging, followed by a palpable mass. Two patients were diagnosed with malignancy on biopsy. Biopsies were most frequently ordered by breast surgeons or medicine practitioners and only 38% of the time was plastic surgery as notified. Pathology, volume of fat grafted, number of sessions, family history, genetics (BRCA positivity), nor follow-up were significant predictors of additional imaging or procedures.
Conclusion
Fat grafting continues to be an oncologically safe and aesthetically powerful reconstructive option. However, in the absence of a trained professional, the natural history of fat grafting procedures may lead to unnecessary invasive and non-invasive procedures. Appropriate patient and care-giver education may decrease this economic and psychological burden.
