Thoughts on Preoperative Risk Factors and Complication Rates of Breast Augmentation With Fat Grafting Free

We read with great interest the article entitled “Preoperative Risk Factors and Complication Rates of Breast Augmentation With Fat Grafting” by Lyly Nguyen et al¹ aimed at determining the major complications and risk factors for patients undergoing autologous fat grafting (AFG) breast augmentation vs implant-based breast augmentation. The authors presented a retrospective review of 789 patients who underwent breast augmentation with AFG, and 18,544 patients who received implants. The conclusion showed that infection and hematoma were the most common postoperative complications in AFG breast augmentation, and the incidence of postoperative infection was higher than that in the implant group. Previous articles in the literature have studied the complications and risk factors of AFG breast augmentation.^2,3 However, most of these have investigated AFG in combination with implants or were meta-analyses based on other studies, and no retrospective analysis of AFG breast augmentation alone has been reported. We compliment the authors on the excellent efforts in this respect, and would also like to express some considerations regarding this paper.

First, the authors defined the scope of major postoperative complications as those that occurred within 45 days of the surgery requiring emergency treatment, hospitalization, or reoperation. Although nonmajor complications were excluded and the incidence of complications could be reduced, some minor complications could also affect patients’ satisfaction, such as breast asymmetry, scarring, etc, and therefore we believe that further research is needed. Moreover, the article pointed out that the age, BMI, and ASA classification of the patients in the AFG group were higher than those in the implant group, and the incidence of postoperative infection in the AFG group was also higher. The relationship between these risk factors and infection will also need to be discussed in the future. Smoking can increase the risk of postoperative infection, and the conclusion showed that tobacco use was the only independent risk factor for overall complications and infection. Therefore, future comparative studies on smoking and nonsmoking patients, as well as the use of antibiotics, need further research.

We noticed some minor errors: in Table 1, the number of ≥40-year-old patients in the AFG group was 458, and the total number of patients of all ages in the AFG group should be 786 (3 data for age are missing), accounting for 58.3%, instead of the 60.3% in the table. Similarly, the percentage of anesthesia in the AFG group has the same issue.

We are very grateful to the authors for carrying out this study, which has brought us to understand the complications and risk factors of AFG breast augmentation. We also hope to see more in-depth studies in the future, such as fat handling techniques, surgical techniques, perioperative management, and others.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

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