OBJECTIVES: Autologous fat grafting (AFG) is increasing every year, with 30,516 procedures in reconstructive breast surgery performed in the United States in 2016. With limited reimbursement for AFG, it is important to select an efficient processing technique to minimize the hospital economic burden.

METHODS: A preliminary economic model was developed based on a prospective, randomized time-and-motion study comparing three AFG techniques (a passive washing-filtration system [PF], an active washing-filtration system [AF], and centrifugation [C]). The primary outcome was rate of fat processed (ml/minute). Volume of fat injected/patient and total AFG time was used to derive AFG rate. Standard operating room cost/minute and device cost were used to estimate the total cost for AFG. Threshold and sensitivity analyses were conducted to characterize cost uncertainty.

RESULTS: Forty-six patients were included in the study (n=15 for PF, n=15 for AF, and n=16 for C), with comparable patient and clinical characteristics between groups. The time to inject 150 ml of fat/patient was significantly lower with AF compared with either PF or C (105.1 min vs 163.4 or 290.0 min, respectively). The total cost saving with AF was $2,862.66 ($1,335.29–$4,390.04) vs PF and $6,839.25 ($4,129.11–$9,549.39) vs C. Threshold analyses identified a minimum of 10.2 ml of fat had to be injected/patient to see cost savings with AF vs C. Cost savings were always seen with AF compared with PF, regardless of the volume of fat injected, unless the cost of PF was assumed to be lower than AF.

CONCLUSIONS: This is the first randomized study of AFG techniques to demonstrate that AF had significantly faster fat processing and grafting rates, translating into potential cost savings vs PF and C. These results can aid surgeons in selecting an efficient processing method considering the absence of reimbursement in AFG.