Background: Fat necrosis is a common complication from autologous breast reconstruction that can compromise the aesthetic outcome and can be confused with recurrent breast cancer. Removal of fat necrosis through direct excision can be difficult with lesions in the periphery and may result in contour deformities. The article describes a case series of patients with fat necrosis treated with ultrasound-assisted liposuction. Methods: A retrospective database was created consisting of consecutive patients treated with ultrasound-assisted liposuction at a single academic institution. Patient demographics and complications were identified, including initial size of fat necrosis, number of ultrasound-assisted liposuction treatments, and final size of fat necrosis. Surgical technique was standardized over the entire series. Results: There were 54 breast reconstructions with fat necrosis treated with ultrasound-assisted liposuction. The average initial size of fat necrosis was 2.72 cm. Twenty-seven lesions (50.0 percent) were treated once, 20 (37.0 percent) were treated twice, and seven (13.0 percent) were treated three times. The final size of fat necrosis was 0.44 cm (p < 0.0001), with an average time to follow-up of 17.8 months. Complete resolution (<0.5 cm) was seen in 44 lesions (81.5 percent). Only one complication, a thermal burn, was seen from ultrasound-assisted liposuction, and this resolved with conservative management. Conclusions: This case series describes the successful use of ultrasound-assisted liposuction for treatment of fat necrosis after autologous breast reconstruction. The authors find this technique to be safe, effective, and reproducible, as the majority of fat necrosis areas resolved with one or two treatments.
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