Thursday, January 19, 2012

Fat Grafting in Breast Reconstruction - What's the Scoop?

Fat grafting has been in the news a fair amount so I thought I'd give you a brief run-down of what's involved....

Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.

Fat grafting can be used to fill-in partial breast defects after lumpectomy. It is also frequently used after mastectomy, usually in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results.

There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells (and fat stem cells they contain) must be optimized to obtain the best long-lasting results.

Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.

Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.

As for the risks.... For women still undergoing regular mammograms, it is also important to know that fat grafting can also cause calcifications known as "MACRO-calcifications". As many of you have already unfortunately experienced, breast cancer can also cause calcifications, known as "MICRO-calcifications". According to the American Society of Radiology, these different types of calcifications are easily distinguishable. Having said that, I still tell my patients that fat grafting can lead to the recommendation for further tests in the future because of this calcification issue.

Injected fat can also become firm or create "oil cysts". Fortunately these are becoming much less frequent as techniques are refined but again, both of these can cause "unnecessary" stress.

Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is safe. However, because the technique is fairly new, no long-term safety data is currently available.

Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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10 comments:

Anonymous said...

Is it possible to do fat grafting for who woman who havent had breast cancer?

Dr C said...

Yes it is. Fat grafting can also be performed for cosmetic breast augmentation as an alternative to breast implants.

JLC said...

So will you be using fat grafting to create a new breast after mastectomy? Do you think fat can be harvested and banked for future use thus avoiding multiple surgical procedures for harvesting?

Anonymous said...

What do prices range from .I want to do a mommy makeover but havent found a dr who does mommy makeover and who would perform grafting of the fat to the breast becuase all I want is a breast lift(breastfeeding) and a tummy tuck because the csection has made an indention wear the incescion was made

Dr C said...

Unfortunately it's impossible to provide exact quotes for cosmetic procedures like mommy makeovers without a formal evaluation.
However, we can provide general cost estimates if you'd like to give the office a call on (800) 692-5565.

Dr C said...

@JLC, That's a great question. Fat grafting is not actually a great option to reconstruct a whole breast for most women. It's more of an adjunct to be used in conjunction with other forms of breast reconstruction in most cases. Even in those patients that are small breasted, several fat grafting procedures are required if fat grafting is the only reconstructive technique being used. The Diep flap is still very much the gold standard in breast reconstruction, at least for the foreseeable future.

As for "banking", right now that's not an option. No clinical studies (at least that I know of) have looked at using banked fat. We do know however that success rates are highest in patients when the fat is outside the body for the least amount of time. That strongly favors re-injecting the fat "there-and-then".

Anonymous said...

I didnt asked the question right but you did answer part of it of my other question, what meant to ask do you perform mommy makeovers and fat grafting im ok with how breast look like but just want them as perky as when was 16 im a full c but a small d I would like them to look fuller I see that you said ,if you have enough fat to harvest can you get at least a cup size bigger

Dr C said...

Yes that's right, and we do offer it at PRMA. Most women can achieve a 1/2 to 1 cup increase in size if they have enough fat. Without formally evaluating you I don't think anyone can guarantee you'll look as perky as you did when you were 16 though!

Anonymous said...

I had nipple sparing implant surgery after i originally had a lumpectomy with clean margins. My nipples are now not in the center of the breast and my surgeon is telling me not much can be done. It is obvious in t-shirts. Is it true that no amount of fat grafting could push the nipple closer to center? It has only been 7 weeks so I can't undergo grafting for awhile in any case. I'm also under going radiation now.

Dr C said...

Thank you for your question.

Radiation can certainly impact things and further change the way your breast (and implant) looks and feels. Unfortunately, any decision in terms of what's needed for the best cosmetic results can't be made until you've completed radiation.

Generally speaking, if lumpectomy has removed a significant portion of the breast it is more likely multiple sessions of fat grafting will be needed. This may be combined with other tecniques like scar tissue release. The nipple-areolar can also sometimes be repositioned but this depends on the position and length of your breast scars from the previous surgery.

A lot also depends on how the implant responds to the radiation.

Dr C
www.PRMA-enhance.com