Is Fat Grafting for the Breast Recommened or Safe After a Bilateral Prophylactic Mastectomy?

I am 23 and in one week I am having a bilateral prophylactic mastectomy with expanders to implants. I just heard about fat grafting. I am 5' 3", 115lbs and most of my fat are my D size breast. I plan to stay my size or a little smaller when I get implants & know I can't get to that size just by fat grafting. Is it safe if I decide to do a smaller implant then later do fat grafting to help give it a more natural feel? Is there much research about these yet?

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11 Doctor Answers | Asked by purelove5 in Houston, TX

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Fat transfer is recommended for breast reconstructions in some cases

Fat transfer is an excellent choice for mastectomy reconstruction in some cases, with exclusions. I encourage you to visit sites like the Miami Breast Center to view a very large series of mastectomy reconstructions. The procedure is very laborious, but in my opinion it is worth evaluating if it fits your personal options in terms of lifestyle. There is a wealth of research on the matter, but it is not so easily available to patients, as most studies are relatively recent... more

Breast Reconstruction Using Fat Grafting

Breast reconstruction using fat grafting is a viable and safe alternative to expander-implant or free tissue transfer in the right circumstances. There has been extensive research and clinical experience in this field. There have been several clinical teaching courses, including the Miami Fat Grafting course directed by Dr. Roger Khouri. See the links below. You must have sufficient fat, however, to achieve the size you want, and this will be the limiting problem. If you... more

Fat grafting for breast reconstruction

Fat grafting for breast reconstruction is an option fo breast reconstruction for small to moderate sized breasts. One of the main limiting factors is the amount of fat you have to donate to fat grafting. At 115 lbs, you probably don't have a lot of donor sites. There is not a wealth of research yet regarding this but preliminary studies are promising and more data is being collected and published every day. Fat grafting techniques are improving which is leading... more

Prophylactic mastectomy and consideration for later fat grafting after immediate reconstruction

The present course of action that you have scheduled is prudent. Later on you can consider fat grafting to further embellish and augment your results. However, at your weight, you may not have bottomless resevoir of fat available for the fat grafting so I would not necessarily request smaller than reasonable implants. Though usage of fat grafting in breast reconstruction and even for breast augmentation is becoming more popular and commonplace and we haven't seen any major health... more

Reconstruction.

I assume you are BRCA positive. If so, I would also assume you have had discussions regarding the timing of mastectomies and/or oophorectomy. If not, you should do so. There are a number of very good surgeons in Houston to pick from. If you proceed, initial expander placement followed by implants is my preference. Skin and nipple/areolar sparing should be highly considered. With the newer gel implants & dermal matrix grafts, I almost never go sub-pectoral any more. With the size of... more

You are not a good candidte for fat grafting alone

You should ask your surgeon about nipple sparing mastectomy and see if you are a candidate. I would think that you do not have enough fat for fat grafting alone to give good result. Implant reconstruction and fat grafting later on can be a good option. You also ask your plastic surgeon about avoiding the expander and do the implant reconstruction post mastectomy if you are not getting radiation treatment. What is the reason for the mastectomy?

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Fat grafting to the breast

Your plan is a good one. To be a D you'll need implants or DIEP flaps after bilateral mastectomies. If you choose implants, then fat grafting down the track will reliably improve the feel and naturalness, so go for it. Given your youth, you should not have flaps, implants would be the best option as it will not scar you elsewhere or affect future pregnancies through abdominal wall surgery. Not sure why you need expanders if you can have a skin sparing mastectomy... more

Fat grafting after breast reconstruction

While it may be difficult to obtain a "D" cup with fat grafting alone, the use of fat grafting as an adjunct in breast reconstruction is becoming accepted. Fat grafting can be used to improve contour irregularities, rippling, or minor asymmetries following reconstruction. It is less commonly used to increase volume following breast reconstruction. These are questions you may want to discuss with your plastic surgeon. As to its safety, we do know that grafted... more

No evidence for fat grafting danger in the breast area

While there have been no direct studies looking in the future longterm after fat grafting, concerns about fat grafting resulting in mammographic abnormalites or impairing breast cancer diagnosis have been alleviated. The only problematic issue we see with fat grafting is absorption of the fat over time, and most maintain about 50% of the fat grafted. Second and third procedures may be performed to reach a better end point. I have enjoyed performing fat grafting to the breast in my practice.... more

Studies so far indicate the procedure is safe

You are correct that getting to a D cup in one procedure is not possible with fat grafting. However with multiple procedures and use of the BRAVA® device, and assuming you have adequate fat, there is not really a limit on size, within reason. 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... more

Fat grafting to help breast reconstruction with implants

The use of fat grafts has become fairly common with breast reconstruction, usually to improve contours and shape rather than to add volume. I would hope that your plastic surgeon will use an acellular dermal matrix (such as Alloderm) for an internal bra, which will add support and coverage. Once everything is healed you can see whether some fat grafting can improve the results.