Curious about fat grafting and how it can improve your implant or tissue flap breast reconstruction? The following guest blog by Wojciech Dec, MD explains how transferring fat from the thighs, tummy or hips to the breast can improve reconstructive results after lumpectomy or breast reconstruction. Use the Archives menu to the right to read a blog on the safety of fat grafting used for breast reconstruction.
The goal of every breast reconstruction is to produce a soft, symmetric breast with inconspicuous scars and a natural contour. Sometimes a breast reconstruction revision step is required to achieve these goals. There are many tools in the plastic surgeon’s armamentarium to help convert a good quality breast reconstruction into a great one. Fat grafting is one technique that can be used in breast reconstruction revision. It is ideal for smoothing out breast contour irregularities or for slightly increasing the volume of a reconstructed breast. The ideal timing for any revision procedure is a minimum of three to six months following the original operation so that your tissues have had time to fully recover.
Unlike flap surgery, which involves the transfer of a substantial volume of fat and skin along with its blood supply to reconstruct the whole breast, fat grafting transfers a smaller quantity of fat. The volume of fat that can be transferred through fat grafting is limited by the ability of the fat to absorb nutrients from its new surrounding environment. During fat grafting excess fat is removed from one part of the body, such as the abdomen or thighs, through liposuction and is injected into the breast. Since no blood supply is brought with the grafted fat, some of it (typically 30-50%) will resorb over time.
Fat grafting can be used after implant-based reconstruction, after reconstruction with your own tissue, or following a lumpectomy. When used with implants, it is ideal for disguising surface irregularities, camouflaging implant rippling, and creating a natural transition between the chest and the reconstructed breast. Typically the tissue covering an implant is too thin to support the volume of fat that would be required to significantly increase the breast cup size. In cases where this is desired, an implant exchange to a larger size may be a better procedure. Fat grafting has all of the same potential benefits following an autologous breast reconstruction, such as a DIEP flap. In this situation the flap tissue can actually accept and nourish a more substantial volume of grafted fat. Therefore a moderate increase in breast cup size can be achieved with fat grafting of a breast flap.
A lumpectomy procedure can unbalance the symmetry between the breasts. Fat grafting can restore the missing breast volume following a lumpectomy, as illustrated in the attached patient photographs. Additionally, when fat grafting is performed after previous breast radiation, some patients and surgeons have noticed an improvement in the texture of the overlying skin.
Recovery following any revision procedure, including fat grafting, is generally quick. Nearly all revision procedures are performed on an outpatient basis with a short subsequent downtime. Incisions are limited to small puncture sites, about 2-4 mm in size, through which liposuction and fat grafting cannulas can be introduced. These incisions can typically be placed along old scars, natural skin creases, or in other inconspicuous locations. Most patients may feel sore for a few days, are able to return to work within a week, and feel normal within a couple of weeks.
Any surgical procedure carries with it some risk for complications or suboptimal outcomes. In fat grafting, typically the greatest source of disappointment is incomplete graft take and loss of some of the transferred volume. The graft and donor sites need to be evaluated by your plastic surgeon postoperatively to ensure that you have not developed an infection. An infection may present with increased pain, redness, and heat in the area, or fever and a generalized feeling of not being well. Fat embolism is a rare but serious complication that can be minimized with proper fat grafting technique. The transferred fat may develop small calcifications, which can feel like firm nodules if they are close to the skin surface. A breast radiologist will be able to distinguish these from the micro-calcifications associated with a potential breast cancer recurrence.
Wojciech Dec, MD provides breast reconstruction, including direct-to-implant and DIEP flaps, in New York.