Epipericardial fat necrosis as a differential diagnosis of acute chest pain: a case report and algorithm proposal for diagnostic approach

ABSTRACT Chest pain is a frequent, potentially life-threatening condition in the emergency department and requires immediate investigation and treatment. This case report highlights a rare differential diagnosis of pleuritic chest pain: epipericardial fat necrosis. A 29-year-old man presented with normal clinical evaluation, electrocardiography, point-of-care ultrasound, and unremarkable laboratory tests. The initial hypothesis was acute pleuritis. Chest radiography revealed peri-cardiac nonspecific findings, and computed tomography revealed epicardial fat necrosis. Despite the rarity of this condition, accurate diagnosis allows for better practices. An algorithm for a diagnostic approach is proposed.

Analysis of clues to pathological diagnosis of panniculitis / 中华皮肤科杂志

Panniculitis is a group of skin diseases involving subcutaneous adipose tissues, including primary and secondary panniculitis associated with tumors and inflammations. According to patterns of inflammation and types of fat necrosis, and combined with the learning experience at Ackerman Academy of Dermatopathology, the authors summarize pathological changes in various types of primary panniculitis, and propose some diagnostic clues, hoping to provide some ideas for the pathological diagnosis of panniculitis.

Pancreatic panniculitis in systemic lupus erythematosus and Crohn's disease: rare event / Paniculite pancreática no lúpus eritematoso sistêmico e na doença de Crohn: raro evento

ABSTRACT Pancreatic panniculitis (PP) is a rare manifestation of pancreatic disease, involving subcutaneous adipose tissue. We report two cases of this entity: a 37-year-old female patient with systemic lupus erythematosus (SLE) and an elderly woman with Crohn's disease. These are two chronic autoimmune inflammatory diseases that can be uncommonly related to acute pancreatitis and that culminates in PP. We also provide a brief review of the treatment, diagnosis and morphology of the lesions, as well as the pathophysiology of the disease. The importance of histopathological analysis of lesion biopsies is highlighted as an important diagnostic tool.

RESUMEN La paniculitis pancreática (PP) es una manifestación rara de enfermedad pancreática que afecta el tejido graso subcutáneo. Reportamos dos casos de esa entidad: una paciente del sexo femenino, 37 años, con lupus eritematoso sistémico (LES), y una anciana con enfermedad de Crohn. Ambas manifestaciones son enfermedades crónicas autoinmunes raramente relacionadas con el cuadro de pancreatitis aguda y que culminaron en PP. También hicimos una breve revisión acerca de tratamiento, diagnóstico y morfología de las lesiones, así como fisiopatología de la enfermedad. Se resalta la importancia de la inmunohistoquímica y del análisis histopatológico de biopsias de la lesión como herramientas diagnósticas.

RESUMO A paniculite pancreática (PP) é uma manifestação rara de doença pancreática que acomete o tecido adiposo subcutâneo. Relatamos dois casos dessa entidade: uma paciente do sexo feminino, 37 anos, portadora de lúpus eritematoso sistêmico (LES) e uma idosa com doença de Crohn. Ambas manifestações são doenças inflamatórias crônicas autoimunes raramente relacionadas com o quadro de pancreatite aguda e que culminaram em PP. Também fizemos uma breve revisão sobre tratamento, diagnóstico e morfologia das lesões, bem como da fisiopatologia da doença. Destacamos a importância da imuno-histoquímica e da análise histopatológica de biópsias da lesão como ferramentas diagnósticas.

Neonatal hypercalcemia associated with extensive subcutaneous fat necrosis: a case report

Subcutaneous fat necrosis (SCFN) of the newborn is rare self-limited fat tissue inflammation that usually occurs in term or post-term newborns exposed to perinatal stress factors, such as perinatal asphyxia, meconium aspiration, neonatal sepsis, and therapeutic hypothermia. SCFN usually appears in the first few weeks of life and has a benign course with spontaneous resolution. Monitoring for complications, in particular the potentially life-threatening hypercalcemia, is crucial. In this report, we describe a male infant with extensive SCFN and neonatal hypercalcemia that went through a prolonged course.

Necrosis grasa del recién nacido / Fat necrosis of the newborn

Resumen: Introducción: Las paniculitis constituyen un grupo de enfermedades que afectan al tejido graso subcutáneo y se manifiestan clínicamente como nódulos. Su patogenia no es del todo clara, por lo general es asintomático. El diagnóstico confirmatorio es histológico. Objetivo: describir las características clínicas e histopatológicas de un caso de necrosis grasa, una forma especifica de paniculitis en el recién nacido (RN). Caso Clínico: RN femenino de 40 semanas, parto cesárea de urgencia por taqui cardia fetal más meconio, APGAR 7-8-9. Requirió oxigeno y presión positiva por 5 min. Al quinto día de vida presentó aumento de volumen en tronco posterior, de coloración eritematosa - violácea, remitente a la palpación, no doloroso. Ecotomografría de piel y partes blandas informó aumento de la ecogenecidad del tejido celular subcutáneo y pérdida de definición de las celdillas adiposas de aproximadamente 42.3 x 9.7 x 20.1 mm, sin presencia de vascularización. Biopsia de piel: epidermis con acantosis irregular y ortoqueratosis en cestas; dermis papilar con infiltrado inflamatorio y dermis reticular y tejido adiposo con presencia de infiltrado linfohistocitiario con tendencia a la formación de nódulos, sin compromiso vascular, leves depósitos de colesterol; compatible con necrosis grasa del recién nacido (NGRN). Paciente tuvo regresión completa de la lesión a los tres meses de vida. Conclusiones: se describe un caso compatible clínica e histológicamente con NGRN; sin complica ciones durante su observación. Por lo general esta patología tiene buen pronóstico, con resolución espontánea, como en nuestro caso.

Abstract: Introduction: Panniculitis is a group of diseases that affect subcutaneous fat tissue and clinically manifest as nodules. Its pathogenesis is not entirely clear, and it is usually asymptomatic. The confirma tory diagnosis is histological. Objective: To describe the clinical and histopathological characteristics of a case of fat necrosis, a specific form of panniculitis in the newborn (NB). Clinical Case: 40-week female NB, born by emergency cesarean section due to fetal tachycardia with meconium, Apgar score 7-8-9. She required oxygen and positive pressure for five minutes. On the fifth day of life, she presen ted an increased volume in the posterior trunk region, with an erythematous - purplish discoloration, which is soft and non-tender to palpation. Skin and soft tissues ultrasound showed increased echo genicity of the subcutaneous cellular tissue and loss of definition of the adipocytes of 42.3 x 9.7 x 20.1 mm approximately, without vascularization. Skin biopsy showed epidermis with irregular acanthosis and basket-weave orthokeratosis; papillary dermis with inflammatory infiltrate, and reticular dermis and adipose tissue with presence of lymphohistiocytic infiltrate with a tendency to form nodules, without vascular involvement, and small cholesterol deposits, compatible with subcutaneous fat ne crosis (SBFN) of the newborn. The patient at three months of age had complete regression of the lesion. Conclusions: a clinically and histologically compatible case with SBFN is described, that did not present complications during observation. In general, this pathology has a good prognosis, with spontaneous resolution as in our case.

Supervivencia del injerto graso. Factores pronósticos / Survival of the fatty graft. Prognostic factors

Utilizar la grasa del propio paciente como material de elección para restaurar volúmenes permite describir distintas formas de obtención de la misma; con o sin infiltración de la zona donante, distintas presiones negativas de succión; diferentes tipos de procesamiento (lavado, filtrado, decantación o centrifugación) y varias formas de implantarla según el plano utilizado, el grosor de los depósitos, la separación de los mismos entre sí, con resultados muy dispares. Para aumentar el volumen de una región, basta con obtener grasa y colocarla en el sitio deseado, siempre sobrevivirá una parte del injerto y siempre existirá una célula madre propia dirigiendo el proceso regenerativo. Pero, ¿cómo lograr que sobreviva todo el tejido trasplantado? La diversidad de criterios aún discutibles, unido a la falta de métodos objetivos no invasivos de evaluación de la sobrevida de los adipocitos, hacen que surja la necesidad de establecer las variables predictoras de supervivencia del lipoinjerto.

Using the patient's own fat as the material of choice to restore volumes has led to the description of different ways of obtaining it; with or without infiltration of the donor area, different negative suction pressures; different types of processing (washing, filtering, decanting or centrifuging) and various ways of implanting it according to the plane used, the thickness of the deposits, their separation from each other, with very different results. To increase the volume of a region, it is enough to obtain fat and place it in the desired site, a part of the graft will always survive and there will always be its own stem cell directing the regenerative process. But how to make all the transplanted tissue survive? The diversity of still debatable criteria, together with the lack of objective non - invasive methods to assess adipocyte survival, lead to the need to establish the predictive variables for lipograft survival.

Clinical report of cheek mass after injection and filling of hyaluronic acid in the cheek / 口腔疾病防治

Objective@#To investigate the clinical characteristics, differential diagnosis and treatment of cheek mass caused by hyaluronic acid injection. @*Methods@#From March 2014 to December 2018, data from 5 patients with cheek masses caused by cosmetic fillings admitted to the First Hospital of Shanxi Medical University were collected, and their clinical, imaging, surgical and pathological features were summarized. @*Results@#All 5 patients were young females with a history of facial hyaluronic acid filling injection. Their clinical features were buccal and facial nodular masses, all of which were treated with surgery. The pathological report was fibrous adipose tissue with fat necrosis, and chronic inflammatory cell infiltration was observed in the interstitium. After the operation, the face shape was basically symmetrical, and there were no symptoms such as infection, limited mouth opening or facial paralysis.@* Conclusion @#The injection of facial hyaluronic acid may cause complications of nodular masses in the cheek, and intraoral resection is an effective treatment with good prognosis.

Factors of fat necrosis after breast reconstruction with autologous fat graft / 中华医学美学美容杂志

Objective To investigate the related factors of fat necrosis nodules after autologous fat grafting for breast reconstruction.Methods Different methods of purification,number of operations,and history of breast radiation were analyzed.The relationship between fat graft and necrosis were compared.A total of 48 patients undergoing autologous transplantation for breast reconstruction after radical mastectomy between January 2015 and June 2017 in Chinese Academy of Medical Sciences were retrospectively analyzed,and 51 breasts were used.Results After surgery,9 cases of palpable nodules were found in the breast,including 8 cases in the centrifuge group and 1 case in the sedimentation group.There were 20 cases of multiple hypoechoic nodules in breast ultrasound,including 13 cases in the centrifugation group and 7 cases in the sedimentation group.The incidence of breast nodules in the centrifuge group was 33.33％,and the incidence of fat liquefaction cysts was 54.17％;the incidence of breast nodules in the sedimentation group was 3.7％,and the incidence of fat liquefaction cysts was 25.93％.In this study,there were 4 cases of breast fat filling surgery,18 cases of fat graft for 2 times,23 cases of breast fat filling for 3 times,and 6 cases of fat filling for 4 times;the more time of fat graft surgery,the higher of the fat necrosis incidence.There were 21 cases of breasts with radiotherapy history,30 cases of breast without radiotherapy history,7 cases of nodules after autologous fat transplantation and breast reconstruction in radiotherapy group,2 cases of nodules that could be touched after autologous fat transplantation without breast reconstruction,and 2 cases with radio therapy.The incidence of fat necrosis after fat transplantation breast reconstruction was higher than those without radiotherapy.Conclusions The incidence of fat necrosis after fat-purified with centrifugation autologous grafting for breast reconstruction is higher than that by sedimentation method.The higher rate of fat necrosis is observed after breast reconstruction with autologous fat grafting in radiotherapy than that without radiotherapy.

Alternativa técnica para tratamento de esteatonecrose em mama: descrição e resultados / Alternative technique for the treatment of osteonecrosis in breasts: description and results

Introdução: Este trabalho descreve e apresenta os resultados de uma técnica alternativa para tratamento da esteatonecrose, a lipoaspiração com cânula específica, com bons resultados observados no exame físico e de imagem. A esteatonecrose é uma complicação que ocorre com alguma frequência nas cirurgias mamárias, principalmente nas reconstruções mamárias, nas cirurgias conservadoras ou TRAM, caracterizando-se, inicialmente, por endurecimento de uma região, que evolui para uma nodulação de tamanhos variados, em qualquer região mamária, com cistos oleosos e fibrose, que traduz uma preocupação constante por parte das pacientes, do oncologista, do mastologista e do cirurgião plástico devido à ocorrência de recidiva tumoral. Método: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas a procedimentos nas mamas, seja reconstrução ou estética, e evoluíram com esteatonecrose, sendo submetidas ao tratamento com lipoaspiração, inspirada na técnica de perfuração óssea para tratamento de necrose óssea, realizado por ortopedistas. Resultados: No período englobado, 8 pacientes foram selecionadas. A idade média foi de 56 anos. Grande parte possuía alguma deformidade na mama acometida, sendo o cisto oleoso o mais comum - 5 pacientes (62,5%). 75% possuíam história de neoplasia mamária. Conclusão: A individualização do paciente é a chave para o sucesso do tratamento da esteatonecrose e uma ferramenta essencial para atender às expectativas e anseios da paciente após essa complicação. Cada técnica tem suas indicações, vantagens e limitações, que devem ser amplamente discutidas com o paciente visando o melhor resultado possível.

Introduction: This work describes and presents the results of an alternative technique for treating steatonecrosis by liposuction using a specific cannula, with good physical and imaging results. Steatonecrosis is a complication that frequently occurs during mammary surgeries, especially during mammary reconstructions and in conservative surgery or TRAM. Steatonecrosis is characterized initially by hardening of the tissue that may develop into nodules of different sizes in any mammary region with oily cysts and fibrosis; consequently, steatonecrosis is a constant concern for patients, oncologists, breast cancer specialists, and plastic surgeons due to the possibility of tumor recurrence. Method: A retrospective review of the medical records of the patients undergoing procedures related to the breast, either reconstructive or aesthetic, was performed. Patients who developed steatonecrosis and were treated by liposuction, similar to the bone drilling technique performed by orthopedic surgeons for the treatment of bone necrosis, were included in the study. Results: Eight patients from the study period reviewed were selected. The mean age was 56 years. Most of the patients showed deformity in the affected breast, with oily cysts, reported in 5 patients (62.5%), being the most common deformity. Breast cancer history was reported for 75% of the patients. Conclusion: The individualization of the patient is the key to successful treatment of steatonecrosis and an essential tool to satisfy the expectations and desires of the patient after this complication. Each technique has its indications, advantages and limitations, which should be thoroughly discussed with the patient to obtain the best possible result.

Necrosis grasa subcutánea del recién nacido: reporte de caso y revisión de la literatura / Subcutaneous fat necrosis of the newborn: case report and review of the literature

Resumen: La necrosis grasa subcutánea es una paniculitis poco frecuente, autorresolutiva, que afecta generalmente neonatos de término en las primeras semanas de vida. Se han identificado ciertos factores de riesgo para su desarrollo como asfixia perinatal, hipotermia y aspiración de meconio. Sus complicaciones son infrecuentes, dentro de éstas se destaca la hipercalcemia por su gravedad. Se presenta el caso de un recién nacido que presentó necrosis grasa subcutánea. El diagnóstico se realizó en base a la clínica y el estudio histopatológico. El paciente evolucionó favorablemente con regresión de las lesiones sin complicaciones.

Summary: Subcutaneous fat necrosis is a rare, self-limiting panniculitis, which usually affects full term infants in the first weeks of life. There are several risk factors for its development such as perinatal asphyxia, hypothermia and meconium aspiration. Its complications are unusual, hypercalcemia being the most severe one among all. The study reports the case of a full term new born that presented subcutaneous fat necrosis. The diagnosis was based on clinical findings and histopathological study. The patient improved with regression of lesions, without complications.

Diagnosis and treatment of primary omental torsion: an analysis of 12 cases / 中华全科医师杂志

Objective To analyze the clinical features, diagnosis and treatment of the primary omental torsion (POT).Method The clinical data of 12 patients with POT admitted to our hospital from May 2010 to May 2015 were retrospectively reviewed.The clinical manifestations, laboratory investigation, medical image, treatment and outcomes of patients were analyzed.Results Twelve cases were all males with median age of 50.The POT was diagnosed during surgical exploration and confirmed pathologically after operation.Right abdominal pain was the main complaint in 11 cases, and pain migration to right lower quadrant in 1 case.In physical examination, the local peritonitis signs were elicited, including right quadrant tenderness and rebound tenderness at same location.All cases had mal temperature except one presenting low fever of 37.5 ℃.White blood cell counts was 12×109/L in one case, and(4-10)109/L in other 11 cases.Abdominal solid mass was found in one case by ultrasonic scan, measured 7 cm×5 cm with unclear surrounding boundary.Mesenteric fat opacity and dropsy were shown in 10 cases on CT plain scan, while thickness and effusion of hepatic flexure of colon was found in one case;however, none of them were suggested as POT by these two image study before operation.All patients were gnosed as localized peritonitis or appendicitis clinically before emergent surgical exploration.The necrotic omentum was resected and all patients recovered smoothly.There were no complications in all cases during one-year follow-up.The CT images were reviewed after operation, which indicated that the mesentery of dropsy and the thickened hepatic flexure of colon should be the imaging signs of omental torsion;and also 9 of 12 cases had whirlpools sign.Conclusion The preoperative diagnosis of POT is difficulty, the typical whirlpools sign of abdominal mass on CT imaging is of highly value in diagnosis.The surgical removal of omental infarction is effective and the prognosis is good.

Pancreatic Panniculitis in Patients with Chronic Pancreatitis: Case Report and Review of Literature / 대한소화기학회지

Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis.

Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica: Reporte de un caso / Subcutaneous fat necrosis and persistent hypercalcaemia in a newborn treated with therapeutic neonatal hypothermia: A case report

La hipotermia terapéutica constituye el tratamiento de elección para los recién nacidos con encefalopatía hipóxico-isquémica moderada-grave, que cambia el pronóstico de estos niños y se acepta como una técnica segura y con escasas complicaciones secundarias considerando su beneficio. Un posible efecto adverso es la necrosis grasa subcutánea, una paniculitis transitoria aguda de presentación durante las primeras semanas de vida. Se presenta un caso de un recién nacido a término afecto de encefalopatía hipóxico-isquémica con lesiones cutáneas en forma de eritema multiforme generalizado y placas eritematosas firmes e induradas en la espalda, los glúteos y las extremidades a los 12 días de vida, tras el tratamiento con hipotermia. El estudio histopatológico, tras la biopsia cutánea, confirmó la sospecha de necrosis grasa subcutánea. Al mes de vida, presentó cifras elevadas de calcio sérico, que precisaron tratamiento con hidratación intravenosa y diuréticos. La calcemia descendió hasta normalizarse a los 3 meses, con desaparición progresiva de las lesiones cutáneas.

Therapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. We report a case of a newborn at term suffering hypoxic-ischemic encephalopathy with a generalized multiform erythematous rash and firm and indurated plaques over the back, buttocks and extremities on his 12th day of life after being treated with therapeutic hypothermia. Histopathological study after skin punchbiopsy confirmed the suspicion of subcutaneous fat necrosis. The infant developed asymptomatic moderate hypercalcaemia within the first month of life, which was treated with intravenous fluids and diuretics. Serum calcium levels decreased and normalized in 3 months, with progressive disappearance of skin lesions.

Diagnosis of fat necrosis on FNAC – A case report.

Fine needle aspiration (FNA) of the breast has gained significant credibility in the diagnosis of breast diseases especially malignancy. Fat necrosis of the breast is a phenomenon that occurs within breast adipose tissue following exposure to trauma. It can mimic breast cancer clinically or radiologically. FNA of fat necrosis is a useful tool in directing management and treatment of the patients and avoiding unnecessary surgeries although histopathological examination is the gold standard for the final diagnosis.

Membranous lipodystrophy: case report and review of the literature

Membranous lipodystrophy is a distinct type of membranocystic fat necrosis. It is associated with many local and systemic diseases, including vascular disorders. The histopathological changes which characterize this phenomenon are variably sized cysts in the fat lobules of the subcutaneous tissue, which are surrounded by eosinophilic membranes projecting into the cystic space. We report a case of secondary membranous lipodystrophy associated with both hypertension and venous insufficiency.

A Case of Liponecrotic Pseudocyst after Breast Augmentation by Autologous Fat Injection

A 21-year-old woman underwent bilateral augmentation mammoplasty by injection of an unknown volume of fat obtained via trochanteric and abdominal liposuction. The procedure was performed by a surgeon untrained in plastic surgery, at a clinic not affiliated with a hospital. Six months later, she presented to our clinic with a palpable left breast lump. Physical examination revealed a large firm mass occupying the entire upper outer quadrant of the left breast and a normal right breast. Breast ultrasound showed a large, well-defined isoechoic mass in the left upper outer breast. Considering her age, the patient underwent core needle biopsy, since the mass mimicked a phyllodes tumor on ultrasonography. The 14-gauge core needle biopsy demonstrated multiple lipid droplets with some white-yellowish tissue, caused by liquefaction of the injected fat. Histopathologic examination demonstrated the presence of a pseudocyst with fat necrosis, granulomatous reaction to lipid material, and cystic formations containing oily fluid. No signs of malignancy were detected. Surgical excision was performed, and histopathology revealed findings consistent with fat necrosis.

Histomorphological features of pancreas and liver in chronic alcoholics - an analytical study in 390 autopsy cases.

Introduction: Chronic pancreatitis and liver disease are two conditions that commonly co-exist in chronic alcoholics with variable incidences. Aim: To evaluate frequency pancreatitis in patients with a history of chronic alcohol abuse. Materials and Methods: A total of 390 autopsies over 11 year’s period were included in the study. Gross and microscopic assessment of liver and pancreas were performed. Available clinical and laboratory parameters were recorded. Results: Age ranged from 22 to 65 years with a mean age of 45.32 years. All 390 consecutive patients included in the study were males. Majority of the patients had primarily presented with alcohol related liver diseases whereas few had presented with features of pancreatitis. Micronodular cirrhosis was present in 292 cases. Features of chronic pancreatitis were observed in 42 cases and 8 of these cases had associated changes of acute hemorrhagic pancreatitis. Prevalence of pancreatitis was more in cirrhotics as compared to non-cirrhotics, and acute pancreatitis was mostly seen in non-cirrhotics. Dominant pattern of fi brosis was perilobular followed by periductal, intralobular and diffuse. Conclusion: Chronic pancreatitis as evidence by the presence of parenchymal fi brosis was more frequently observed in alcoholic cirrhosis cases than that in non-cirrhotic alcoholic liver disease, thereby suggesting common underlying pathobiology in the development of fi brosis in liver as well as in pancreas.

Subcutaneous fat necrosis in neonate:a case report and literature review / 临床儿科杂志

Objective To investigate diagnostic methods and treatment of subcutaneous fat necrosis in neonate (ScFN). Methods The clinical data of a case with ScFN was reported and the etiology, pathogenesis, and differential diagnosis were reviewed. Results The case was a 2 days female newborn delivered via cesarean section at full-term, and she came to hospital because of indurated nodules and plaques in the back and shoulders. Anti-infection treatment after admission was not effective. On the 10th day in hospital, the back lesions appear as soft and lfuctuant and then diagnosed as ScFN by biopsy which showed a small amount of inflammatory cell infiltration and fatty degeneration. The patient was followed up with good prognosis. Conclusions ScFN is a benign self-limiting fat disease, mostly occurred in the first four weeks of full-term newborns with history of abnormal childbirth.

Autologous Fat Graft in the Reconstructed Breast: Fat Absorption Rate and Safety based on Sonographic Identification

BACKGROUND: Autologous fat graft has become a useful technique for correction of acquired contour deformity in reconstructed breasts. However, there remains controversial regarding the efficacy and safety of the practice for reconstructive breast surgery. METHODS: A retrospective review was performed on 102 patients who had secondary fat grafting after breast reconstruction. Fat harvest, refinement and injection were done by Coleman's technique. All patients were followed up postoperatively within 1 month and after 6 months including physical examination and ultrasonography. In 38 patients, the reabsorption rate was calculated by serial changes of thickness between skin and pectoral fascia in the ultrasonic finding. Locoregional recurrence rate was compared with control group of 449 patients who had breast reconstruction without fat graft in the same time period. RESULTS: Average 49.3 mL fat was injected into each breast. The most common location of fat graft was upper pole, followed by axilla, lower and medial breasts. During 28.7 months of average follow-up period, 2.9% of total patients had symptoms of palpable mass on fat graft side and ultrasonography identified fat necrosis and cyst formation in 17.6% of the patients. Calculated fat reabsorption rate was 32.9%. Locoregional recurrence was occurred in 1 patient (0.9%) and the rate was not different significantly with control group (2%). CONCLUSIONS: Although further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting, we propose autologous fat graft is an efficient and safe technique for secondary breast reconstruction.

Ocular Swelling after Forehead Fat Graft

BACKGROUND: Facial fat grafting is a common cosmetic surgery for facial contouring. Although it is considered a very safe procedure, there are several reports about complications after fat grafting. Eye complications are very rare, but do exist. The author has treated cases of eyelid swelling after forehead fat grafting with conservative or surgical treatment. METHODS: From February 2010 to April 2014, the author treated five women (mean age, 35 years; range 28-52), who developed eyelid swelling (both, n=3; unilateral, n=2) approximately 2 weeks after forehead fat grafting. Symptoms included pain, foreign body sensation, recurrent swelling and redness, unilateral or bilateral ptosis, and palpable lumps. Three were acute cases treated within 1 month, and the other two were chronic cases, which occurred 4 and 28 months after the fat graft. RESULTS: Conservative treatment (Lasix, antibiotics, steroids) was used for two patients. The other three patients were treated with direct fat extraction or lump excision through the double eyelid crease line. Histological examination identified the excised specimens as lipocysts or liopogranulomas. All patients fully recovered, despite transient ptosis for several days immediately after the operation. CONCLUSIONS: Eyelid swelling after forehead fat graft can be successfully treated with either conservative or surgical treatment. Although few studies have reported eyelid swelling after fat grafting, this complication may become more common, in the future, as facial fat grafting becomes more popular. This treatment modality should be helpful to the plastic surgeons faced with these unpleasant complications.