The Effect of Lipoaspirate Processing Technique on Complications in Autologous Fat Grafting for Breast Reconstruction: A Propensity Score Analysis Study

Background The use of autologous fat grafting (AFG) is becoming increasingly common as an adjunct to breast reconstruction. However, there is a paucity of data comparing the varying processing devices. Objectives The goal of this study is to compare the outcomes of two commercially available AFG processing devices. Methods The authors conducted a retrospective review of patients who underwent AFG using dual filter (Puregraft®) or single filter (Revolve TM) processing systems between 2016 and 2019. Propensity score matching was utilized to adjust for confounding. A total of 38 breasts from the Puregraft® group were matched with 38 breasts from the Revolve TM system. Results Matching was successful in achieving a similar distribution of baseline characteristics between the two groups. The mean number of AFG sessions was comparable between the two groups (p=0.37) with a similar median total volume (Puregraft®, 159 ml vs. Revolve TM, 130 ml, p=0.23). Complication rates were similar between the two devices (Puregraft®, 26%; Revolve TM,18%; p=0.47). Patients with at least one complication had higher overall AFG volume (median, 200 vs.130 ml, p=0.03) and number of sessions (mean, 2.4 vs.1.8, p=0.009) compared to those without any postoperative complication. Conclusions The decision for which processing system to use for autologous fat grafting should be based on surgeon preference as overall complication rates were comparable between two commonly used commercially available systems. Future studies are underway to decipher whether either system has superior graft retention, cosmetic or patient reported outcomes.