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      Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery

      case-report

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          Abstract

          Autologous fat grafting has become increasingly popular in the field of aesthetic surgery because of its biocompatibility and low donor site morbidity. However, some fatal complications may occur following the surgery. We herein describe a woman who developed severe fat embolism after autologous fat grafting for vaginal tightening and breast augmentation surgery. The patient developed symptoms of dyspnea and hypoxemia. Computed tomography pulmonary angiography showed multiple filling defects in the bilateral pulmonary arteries and branches with a maximum size of approximately 1.2 × 0.7 cm. Fat embolism was assumed to have occurred by injection of fat directly into the vessels around the vagina. Further research is needed to elucidate the anatomical mechanism underlying this phenomenon.

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          Fat grafting to the breast revisited: safety and efficacy.

          Denis Coleman, Alesia Saboeiro (2007)
          A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.
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            Deaths Caused by Gluteal Lipoinjection

            Lázaro Cárdenas-Camarena, Jorge Bayter, Herley Aguirre-Serrano … (2015)
            Intramuscular gluteal lipoinjection has become one of the most commonly used surgical procedures for achieving improvement in the gluteal contour; however, there are few studies that report and analyze the causes of secondary death from this surgical procedure.
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              Fat Embolism and Fat Embolism Syndrome

              David L Rothberg, Christopher A. Makarewich (2019)
              Fat embolism (FE) occurs frequently after trauma and during orthopaedic procedures involving manipulation of intramedullary contents. Classically characterized as a triad of pulmonary distress, neurologic symptoms, and petechial rash, the clinical entity of FE syndrome is much less common. Both mechanical and biochemical pathophysiologic theories have been proposed with contributions of vascular obstruction and the inflammatory response to embolized fat and trauma. Recent studies have described the relationship of embolized marrow fat with deep venous thrombosis and postsurgical cognitive decline, but without clear treatment strategies. Because treatment is primarily supportive, our focus must be on prevention. In trauma, early fracture stabilization decreases the rate of FE syndrome; however, questions remain regarding the effect of reaming and management of bilateral femur fractures. In arthroplasty, computer navigation and alternative cementation techniques decrease fat embolization, although the clinical implications of these techniques are currently unclear, illustrating the need for ongoing education and research with an aim toward prevention.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 18 August 2020
                Publication date Collection: August 2020
                Volume: 48
                Issue: 8
                Electronic Location Identifier: 0300060520949109
                Affiliations
                [1-0300060520949109]Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
                Author notes
                [*]Xiao Long, Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, China. Email: pumclongxiao@ 123456126.com
                Author information
                https://orcid.org/0000-0002-2958-1588
                Article
                Publisher ID: 10.1177_0300060520949109
                DOI: 10.1177/0300060520949109
                PMC ID: 7441288
                PubMed ID: 32811245
                SO-VID: a5222ca4-d0b1-4f6f-89db-b581751b1251
                Copyright © © The Author(s) 2020
                License:

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 27 March 2020
                Date accepted : 17 July 2020
                Categories
                Subject: Case Report
                Custom metadata
                typesetter ts2

                Keywords: autologous fat grafting,fat embolism,vaginal tightening surgery,breast augmentation,aesthetic surgery,complication
                Data availability:
                Keywords: autologous fat grafting, fat embolism, vaginal tightening surgery, breast augmentation, aesthetic surgery, complication

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