I'm a member

Autologous Fat Grafting to the Breast
Transplantation of autologous fat has been performed for over 100 years, primarily in cosmetic facial surgery. Since the 1980s, there has been an increased interest in autologous fat transfer for breast augmentation; however, variability in long-term results and oncologic concerns have limited its application in the breast. In 1987, the American Society of Plastic and Reconstructive Surgeons (ASPRS) Ad-Hoc Committee on New Procedures determined that fat grafting to the breast region could impede breast cancer detection because of possible complications including fat necrosis, cyst formation and calcifications, and that fat grafting to this area should be avoided.  This position was supported by several subsequent studies that reported severe complications due to fat grafting for breast augmentation. Until 2005, most physicians refrained from performing fat grafting to the breast.

Technical advances in fat grafting such as the development of devices like liposuction cannulae and more sophisticated methods to detect breast cancer, which can provide a relatively precise distinction between microcalcifications associated with fat grafting and those associated with cancer, led physicians to develop improved fat grafting techniques. However, in 2007, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) announced that fat grafting for breast augmentation was still not recommended based on a lack of available clinical data on the safety and efficacy of the procedure and the possibility that the procedure might interfere with cancer detection.

In 2009, the ASPS issued a new position on fat transfer, grafting, and injection to the body, which was based on a review of the literature of patients who had undergone fat grafting (238 of whom underwent fat grafting to the breast).  The ASPS task force concluded that fat grafting could be considered for breast augmentation and to correct defects associated with medical conditions and previous breast operations, although it cautioned that the results are largely dependent on technique and surgeon expertise and that because the lifetime of fat grafts is unknown, additional treatments may be necessary. Although no scientific evidence was found that specifically addressed patient selection, physicians were advised to exercise caution when considering patients at high risk for developing breast cancer (e.g. BRCA-1, BRCA-2, and/or a personal or family history of breast cancer) when determining whether a patient is an appropriate candidate for autologous fat grafting to the breast.

Autologous Fat Grafting to the Breast
Transplantation of autologous fat has been performed for over 100 years, primarily in cosmetic facial surgery. Since the 1980s, there has been an increased interest in autologous fat transfer for breast augmentation; however, variability in long-term results and oncologic concerns have limited its application in the breast. In 1987, the American Society of Plastic and Reconstructive Surgeons (ASPRS) Ad-Hoc Committee on New Procedures determined that fat grafting to the breast region could impede breast cancer detection because of possible complications including fat necrosis, cyst formation and calcifications, and that fat grafting to this area should be avoided.  This position was supported by several subsequent studies that reported severe complications due to fat grafting for breast augmentation. Until 2005, most physicians refrained from performing fat grafting to the breast.

Technical advances in fat grafting such as the development of devices like liposuction cannulae and more sophisticated methods to detect breast cancer, which can provide a relatively precise distinction between microcalcifications associated with fat grafting and those associated with cancer, led physicians to develop improved fat grafting techniques. However, in 2007, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) announced that fat grafting for breast augmentation was still not recommended based on a lack of available clinical data on the safety and efficacy of the procedure and the possibility that the procedure might interfere with cancer detection.

In 2009, the ASPS issued a new position on fat transfer, grafting, and injection to the body, which was based on a review of the literature of patients who had undergone fat grafting (238 of whom underwent fat grafting to the breast).  The ASPS task force concluded that fat grafting could be considered for breast augmentation and to correct defects associated with medical conditions and previous breast operations, although it cautioned that the results are largely dependent on technique and surgeon expertise and that because the lifetime of fat grafts is unknown, additional treatments may be necessary. Although no scientific evidence was found that specifically addressed patient selection, physicians were advised to exercise caution when considering patients at high risk for developing breast cancer (e.g. BRCA-1, BRCA-2, and/or a personal or family history of breast cancer) when determining whether a patient is an appropriate candidate for autologous fat grafting to the breast.

Yoshimura and colleagues, in an effort to address the problems of unpredictability and low rates of fat graft survival, developed a technique known as cell-assisted lipotransfer (CAL), which produces autogenous fat rich in ADSCs.  In CAL, half of the lipoaspirate is centrifuged to obtain a fraction of concentrated ADSCs while the other half is washed, enzymatically digested, filtered and spun down to an ADSC-rich pellet. The latter is then mixed with the former, converting a relatively ADSC-poor aspirated fat to ADSC-rich fat.

A point-of care system is available for concentrating ADSC from mature fat. The Celution™ system (Cytori Therapeutics, Inc.) is designed to transfer a patient’s own adipose tissue from one part of the body to another in the same surgical procedure.

Cytori Therapeutics, Inc. was awarded 510(k) marketing clearance in September 2006 from the U.S. Food and Drug Administration’s Center for Devices and Radiological Health (CDRH) for the Celution™ Cell Concentration System as a cell saver device. The system is cleared for the collection, concentration, washing and re-infusion of a patient’s own cells for applications that may include, but are not limited to, cardiovascular, plastic and reconstructive, orthopedic, vascular, and urological surgeries and procedures.

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Non-Covered Codes

This is not an all-inclusive list of non-covered procedure codes.

All codes billed for this procedure are considered investigational and not eligible for coverage. 

Top