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.
~ SR Coleman, PRS, 2007~
Vincent Czerny, a German physician, first described breast reconstruction by fat transfer in 1895, two years after the first attempts at autologous fat transfer by Neuber. He described a 41-year-old female who required breast reconstruction after mastectomy for chronic interstitial mastitis and fibroadenoma. However, it fell into disfavor in the 1950s owing to technical problems of harvesting and viability, which were diverse without confidence. Peer especially demonstrated that auto-fat transplantation a minimal graft survival one-year post-transplantation. Fat transplantation was concurrent with the increasing use of non-autologous bio-fillers/implants, and its use was relegated to cold storage but without significant success. In the early days of liposuction (80’s), this technique revived in harvesting and transplantation.
There has been evolutional progress, though fat graft’s feasibility has aroused many debates and consensus. However, in 1987, a position paper released by the American Society of Plastic and Reconstructive Surgeons Ad-Hoc Committee on New Procedures was ‘unanimous in deploring the use of fat injection in breast augmentation,’ as its radiological sequelae would compromise the detection of breast cancer on subsequent mammography, and effectively curtailed its practice worldwide. Two decades later, their position is more relaxed. The mentor, Dr. Sydney R Coleman, emphasized in 1987 that “free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures, and 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.”
Moreover, the ASPS (American Society of Plastic Surgeons) announced a guiding principle regarding the potentiality of the clinical application of fat graft in 2009 Jan. Afterward, a guideline for post-mastectomy fat graft and fat transfer was presented in 2012 Dec. by ASPS Executive Committee. However, these guiding principles should not be construed as a rule and are not meant to serve as the standard of medical care. So, when interpreting and applying these guiding principles to their practices, physicians should use their personal and professional judgment.
The authors have deployed the technique of MAFT (micro-autologous fat transplantation) for fat grafting since 2007. The indispensable and innovative performance has demonstrated promising long-term efficacy in facial rejuvenation and recontouring for three thousand cases. More than 300 cases of augmentation mammoplasty (aesthetic reason) and reconstruction post-mastectomy have illustrated the MAFT technique’s feasibility. This presentation will detail the precise technique and clinical results and conclude the potential guideline for further application.

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