Lipothorax Following Autologous Fat Grafting to the Breast.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.