Most breast reconstruction involves a second surgery to revise the shape, size, or appearance of the new breast. Revision surgery can be performed three or four months (or longer) after your initial reconstruction when the swelling has reduced, the tissue has healed and settled into position, and the scar tissue has relaxed.

Revision with fat grafting—fat transferred from your belly, thighs, buttocks, or “love handles”—can improve the appearance of your reconstructed breast. The “from” area becomes somewhat slimmer, while the fat adds a soft fullness to the breast. Your surgeon can transfer fat from a single area or multiple sites.

Fat transferred to your new breast can:

• add volume (up to an additional cup size.

• fill in dimples and dents.

• improve cleavage.

• fill in the upper slope of the breast.

• hide the edges of implants and camouflage rippling and wrinkling.

• improve the texture of previously radiated tissue.

• refine scars.

Fat grafting in three steps

Fat grafting is a minimally invasive outpatient procedure done under local or general anesthesia. Fat is liposuctioned through a small puncture in an inconspicuous spot, usually about a quarter inch. The extracted fat is then cleansed of cellular debris, blood, and excess fluids that can promote inflammation. The remaining healthy fat is loaded into syringes and injected in minuscule amounts in the new breast.

Layering small amounts of fat into different areas of the breast increases the odds that the fat will successfully latch onto small blood vessels. Generally, about 50 percent of the fat harvested will be injected, and 50 to 70 percent of that may remain in the breast—the body will likely resorb the rest. Two or more fat grafting sessions at least three months apart may be needed for optimal results.

Recovery

Downtime is generally minimal with little or no breast discomfort. You'll likely have some swelling, bruising, and tenderness at the liposuction area(s) for a week or two. Most women are up and about the next day and resume work and other normal activities by the second week. Recovery may take longer when more fat or additional donor sites are involved.

You’ll need to wear a medical compression garment at the liposuction site 24/7 (except when you shower) for at least two to three weeks to minimize swelling. Your surgeon will advise if you need it for a while longer. It may take several weeks before the swelling completely subsides. In about three to four months, your breasts will show their final shape and size.