Lipothorax Following Autologous Fat Grafting to the Breast

Why this matters

An exceptionally rare case of bilateral lipothorax following autologous fat grafting to the breast, with imaging features and technical considerations to mitigate risk. This work contributes to evidence-based plastic and reconstructive surgery — helping clinicians interpret outcomes, refine technique, and counsel patients with clearer data.

Author

Dr. Orr Shauly

Plastic and reconstructive surgery resident at Emory University (UCLA BS, USC MD) with an h-index of 18 and peer-reviewed work spanning aesthetic surgery, reconstruction, medical devices, and AI in medicine.

Abstract

We describe an exceptionally rare case of bilateral lipothorax following autologous fat grafting to the breast and highlight imaging features and technical considerations to mitigate risk near parasternal access sites. We report a single-patient case. A 46-year-old woman underwent upper-pole autologous breast fat grafting and was subsequently evaluated clinically and with computed tomography (CT) for postoperative respiratory symptoms. One month postoperatively, the patient presented with progressive pleuritic chest pain and dyspnea. CT demonstrated bilateral bilayered pleural effusions with a fat-density layer floating over dependent fluid, consistent with lipohydrothorax/lipothorax. The authors hypothesize that this was secondary to inadvertent pleural violation by a blunt cannula, with gradual accumulation of lipid material and fluid within the pleural space driven by negative intrathoracic pressure. The patient was managed conservatively and achieved complete symptomatic and radiographic resolution at 1 year. Although autologous breast fat grafting is generally safe, clinicians should maintain a high index of suspicion for intrathoracic complications when postoperative dyspnea occurs. Careful cannula control, particularly near parasternal access sites, may reduce risk, and CT imaging can be diagnostic when fat-containing pleural collections are suspected.