It has been recommended that I have my reconstruction (both sides) using latissimus dorsi followed by Lipofilling as I do not have enough tummy fat for other methods and do not want implants. What are the concerns regarding lipofilling? Do they relate to a possible recurrence of the cancer or are they cosmetic? I am aware that Lipofilling is a relatively new procedure in Breast reconstruction, but there seems to be little information in the public domain about what the concerns may be.
Lipofilling Concerns in Breast Reconstruction?
Doctor Answers (4)
Fat injection for breast reconstruction
Fat injection into the breast is still a bit controversial. You may want to look into other options like perforator flaps from your buttock region This can be harvested at the top of the buttock a superior gluteal artery perforator flap(SGAP) or from the buttock crease or an inferior gluteal artery perforator flap (IGAP).
Lipofilling concerns in breast reconstruction?
At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy. We have utilized the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast. After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques. Our patients have been very happy with the results as well as the areas where the liposuction was performed. Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.
Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.
Many plastic surgeons will use fat injections to fill in small areas of tissue deficit or depression after reconstruction, but most are not performing large quantity fat injections for augmentation or overall breast enlargement (even after reconstruction). Injected fat can reaborb, become necrotic, and calcify. Small areas can be monitored easily, but until we know more about how injected fat behaves with time in the breast, large volume fat injections are not recommended outside of a monitored study. You should know, though, that so far fat injections have not been found to be unsafe, including that there is no evidence that they are associated with a higher risk of cancer.
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"Lipofilling" is new and controversial
Placing fat removed by liposuction into a breast, especially one just treated for cancer, is controversial. Ten years ago, it would have been considered malpractice by many plastic surgeons. The concerns were that the fat may degenerate and the products of that degeneration may make surveillance on the reconstructed breast difficult. As it is so new, I consider patients who have it as "test cases" of sorts. I do not do it and await good studies of those who do to determine whether I ever will or not.
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