Unintentional Intra-Implant Fat Injection During Breast Fat Grafting

Abstract

Background: Fat grafting is commonly used in implant-based breast reconstruction to improve contour and soft-tissue quality. Cannula-related implant injury during fat grafting is considered rare and is infrequently discussed in the literature. Methods: A focused review of PubMed and Embase identified reports describing implant puncture or rupture associated with fat grafting. In addition, we present an institutional case of delayed implant infection following fat grafting, with intraoperative identification of intraprosthetic fat. Results: Four published case reports and a case discussion within a retrospective review of fat grafting patients describe cannula-induced implant puncture with intraprosthetic fat deposition, presenting variably with pain, capsular contracture, shape change, or infection. Larger series report low but non-zero rates of implant injury following fat grafting. Our case involved a radiated breast with delayed infection 18 months after fat grafting; explantation revealed multiple implant punctures and intraprosthetic fat without free silicone extrusion. Conclusions: Cannula-related implant injury during fat grafting is an uncommon but likely underrecognized complication with heterogeneous presentation and limited detectability on imaging. Awareness and adherence to protective techniques are essential to minimize risk.