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Surg Innov. 2018 Dec;25(6):594-601. doi: 10.1177/1553350618798435. Epub 2018 Sep 10.

Autologous Fat Transfer After Augmentation and Reconstruction of the Female Breast: An International, Cross-Sectional Photo-Comparison Study Among Different Physician and Laymen Study Groups.

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1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.
2 Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands.
3 Department of Plastic, Reconstructive and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands.
5 Miami Breast Center, Key Biscayne, Florida, United States.



The aim of this study is to compare the cosmetic evaluation of autologous fat transfer (AFT) for various indications between surgeons and different laymen groups.


Despite the upsurge in AFT scientific/clinical interest, objectifying satisfaction has only recently progressed beyond simple Likert-type/Visual Analog Scales. Furthermore, differences in satisfaction between laymen and surgeons has not been thoroughly studied.


A photo comparison study between European plastic surgeons and different laymen groups was conducted to investigate agreement on cosmetic evaluation of AFT. Three sets of preoperative/postoperative photographs illustrating patients treated with External Vacuum Expansion (EVE) + AFT for various indications in breast surgery were scored according to the Harris Scale, and the interrater agreement was analyzed using Cohen's κ.


The overall agreement between the surgeons and the groups of former augmentation, control group, and deep inferior epigastric artery perforator patients was fair, moderate, and substantial, respectively. Interrater agreements among different laymen groups and surgeons from different countries among themselves was substantial to almost perfect. Finally, we found that laymen are generally more optimistic about postoperative results than surgeons.


In our study, former augmentation patients showed the lowest agreement with surgeons, in the cosmetic appreciation of EVE + AFT and this group might benefit from a more thorough preoperative consultation regarding expectations when choosing AFT. However, overall laymen tend to be more optimistic about postoperative results and surgeon education in general does not seem influenced by surgeon nationality. The significant differences between surgeons and laymen in the cosmetic evaluation of EVE + AFT justifies further studies that focus on the qualitative aspects of these differences to further balance patients' and surgeons' expectations.


EVE; autologous fat transfer; interrater agreement; patients; surgeons

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