I Am Considering Fat Grafting for Asymmetry Correction After Partial Mastectomy and Radiation Therapy (Completed 19 Months Ago).

I've been told that a 50% take can be expected, so I'm sure fat necrosis could be a complication. From what I've read, fat necrosis can sometimes resolve on its own. Are there any other possible complications that I should be aware of? Is fat grafting in a radiated breast generally effective and is it oncologically sound? How long do you have to wait to know how much of the fat survived? Thank you in advance for your response.

Doctor Answers (10)

Correction after partial mastectomy and radiation therapy (completed 19 months ago)?

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Than you for your question!  I typically wait for 6-12 months after completion of radiation before consideration of surgical procedures to the area.  Fat grafting has become a popular procedure to improve aesthetic outcome following breast reconstruction or for improvement of contour after lumpectomy. Much of the newest research has investigated the properties of fat, in terms of its stem cell properties and associated advantages. It has significantly ameliorated radiation damage by increasing vascularity. Also, it adds additional "fatty tissue" atop the reconstructed breast mound to further contour any concavities or deformities, while also masking implant visibility with rippling and such.  It has been shown to be oncologically-safe in several studies. 

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.  Survival rate has been reported as 50-90%, with average of 65-75%, so, the areas are typically over-injected to compensate for this. 

Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.  Hope that this helps!  Best wishes for a wonderful result!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Fat Transfer

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See a Board Certified Plastic Surgeon and all involved in your care to determine your outcome scenarios.  With added scar tissue, the rules change. Thank you for your question and good luck with everything.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 9 reviews

Fat grafting is likely the preferred method of reconstruction for lumpectomy radiation cases

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Stem and Regenerative Cell Enriched Fat grafting is now an approved method of reconstruction for lumpectomy radiation patients in the EU. It is also considered the treatment of choice by the British National Health not just due to the effectivenes but also cost effectiveness. With appropriate technique and using the BRAVA® device, close to 90% fat take can be expected. The stem and regenerative cells in fat, have been clearly shown to have a beneficial effect on radiated tissue. The main complications relate to small oil cysts and calcifications, which are rarely major complications.

Clinical studies to date indicate that breast reconstruction with fat has a similar risk profile to other forms of breast reconstruction in terms of recurrence risk etc. In your case, you have no actual history of cancer, so there should be no issue of recurrence. I provide the references below for a recent recent large study of 880 cases reported by DeLay et al from France, Also quoted is a personal experience study of Dr. Ilouz the originator of liposuction and Petit et al from France.

Longer term follow up is definitely required as with any cancer issues for more definitive information, though at this point there are no obvious problems.

It is important that any surgeon doing these procedures enroll their patients in long term studies similar to the one that I participate in which is a multiinstitutional IRB study of lipofilling for breast reconstruction in combnation with the BRAVA® external expansion device

 

Delay, E., Garson, S., Tousson,G.,Sinna, R. Aesthetic Surgery Journal 29, 5 September/October 2009

Fat Injection to the Breast: Technique,
Results, and Indications Based on
880 Procedures Over 10 Years

Illouz, Y., Sterodimas, A. Aesth Plast Surg Received: 25 March 2009 / Accepted: 11 May 2009

 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2009

Autologous Fat Transplantation to the Breast: A Personal

Technique with 25 Years of Experience

J. Y. Petit1,*, E. Botteri2, V. Lohsiriwat1,3, M. Rietjens1, F. De Lorenzi1, C. Garusi1, F. Rossetto1, S. Martella1, A. Manconi1, F. Bertolini4, G. Curigliano5, P. Veronesi6,7, B. Santillo2 and N. Rotmensz2

Ann Oncol (2011)
doi: 10.1093/annonc/mdr158
First published online: May 24, 2011

Locoregional recurrence risk after lipofilling in breast cancer patients



Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 42 reviews

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Fat transfer in radiated partial mastectomy defects.

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Fat transfer or grafting is a well established reconstructive tool for the correction of contour deformities in the breast. There is some encouraging data to show that the grafted fat may improve the vascularity in radiated patients to a small degree. Complications from fat grafting include infections, fat necrosis, cysts, and irregularities. The fat can be processed in several ways to optimize the "take" rate (how much fat survives). Essentially, careful treatment of the fat cells to prevent injury during harvest and injection is the goal. Limiting the transfer to viable fat cells and eliminating the non-essential products (oil, blood, etc.) is the goal of the processing. This can be done with centrifuges, washing, or simply decanting the fat. Injection focuses on creating tunnels within the area to be grafted and small aliquots of fat administered within these tunnels. This allows for maximum vascularity to the grafted fat and improved take rates. Grafted fat will need revascularization early on or else necrosis occurs. When grafted fat dies, it can form oil cysts or firm lumps that may take months to resolve. Revisions are common, particularly in areas of dense scar.

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#Breast contouring, #BreastAugmentation, #Breastlift, #mastopexy, #Fatgraft to the breasts

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Dear GoGoGirl

Contouring of the breast - post mastectomy and radiation is an excellent treatment for shaping the breast, softening of the scar tissue from the radiation and reversing the effects of the damage caused by the radiation. Complications include infection, lumps/bumps, fat necrosis, sensation changes, poor fat survival, donor site irregularities, fat embolii, drug reactions, DVT, pain, nausea and vomiting- fortunately these are all uncommon.  The procedure is oncologically sound.  You may have to undertake a second grafting procedure.  The BRAVA system is very nice to use- not absolutley necessary. The survival is generally know by 2 to 4 months.  perioperative supplementation is very helpful in preparation and recovery from surgery.

With Warm Regards,

Trevor M Born MD

 

Trevor M. Born, MD
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I Am Considering Fat Grafting for Asymmetry Correction After Partial Mastectomy and Radiation Therapy (Completed 19 Months Ago).

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Fat grafting in a radiated mastectomy area is a difficult process. By 3 months the fat left is what you can expect. Many have multiple sessions of grafting to build up the breast mound. Seek a boarded PS experience with fat grafting. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
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Fat grafting is safe option

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I have large series of fat grafting during last 5 years and it is a great option for reconstruction. You should make sure your surgeon has lots of experience with fat grafting.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
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Fat Grafting works very well for post partial mastectomy deformity.

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Hi.

1)  This is very safe and most patients are very grateful.

2)  Good technique is very very important.  The fat harvesting, processing, and injection have to be done just right.  We inject the pure fat in multiple tiny "string of pearls" deposits, using tiny blunt cannulas.

3)  You can expect at least 80% take with this technique.  The atrophied fat just gets re-absorbed.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
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Fat transfer after partial mastectomy

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I aim for 100% of my fat grafts to take, although obvioulsy this cannot be guaranteed.  If the fat does not take, then you may get fat necrosis, although because the fat is injected in tiny droplets, the areas of fat necrosis are usually small and often settle with time.  Rarely, they will need to be excised.  It is also possible to get oil cysts that may need to be aspirated or excised and the fat graft may get infected and form an abscess.

I frequently perform fat transfer in to radiated tissue and it is said that the fat graft will improve the vascularity to the area.  The oncological side of things has been a potential issue, but mainly when considering using fat grafts to augment the breast instead of implants (see recent advice from BAAPS in the link below).  Because you will be under follow up because of your breast cancer, it is a widely accepted and very effective method of improving asymmetries in cases such as yours.

Jonathan J. Staiano, FRCS (Plast)
Birmingham Plastic Surgeon
5.0 out of 5 stars 9 reviews

Fat grafting in the radiated breast

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it is safe. to be done effectively with as much take as possible, pre-expansion with a BRAVA device should be done.  IMHO fat grafting to partial defects of radiated tissue in the breast is the preferred technique. Dr. Rafael Cabrera

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

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