Long-term volume retention of breast augmentation with fat grafting depends on weight changes: A 3-Year Prospective Magnetic Resonance Imaging Study

BACKGROUND: Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood.

METHODS: In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with magnetic resonance imaging preoperatively and up to 3 years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. In addition, we used their model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft-to-recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire.

RESULTS: The study included 28 patients (46 breasts). The time to steady state was 253 days (95% CI, 185 to 283 days) postoperatively, with a volume retention of 46% (95% CI, 35% to 58%). Patients with a weight loss of 1 body mass index point after surgery had a volume retention of 22% (95% CI, 4.7% to 38%), whereas those increasing 1 and 2 body mass index points had retention rates of 57% (95% CI, 45% to 69%) and 85% (95% CI, 72% to 98%), respectively. Increasing graft-to-recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative Satisfaction with Breasts and Sexual Well-Being increased substantially.

CONCLUSIONS: Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.