Hollowed Breasts After Mastectomy with Implant Reconstruction

One of the newest techniques for breast reconstruction involve utilization of the exciting benefits of fat grafting. Much research has been put forth into plastic surgery for harvesting of fat and its potential as stem cells. Fat grafting and transfer has been utilized both for breast augmentation but also in breast reconstruction for contouring of the breast after implant-based and flap-based reconstruction with excellent results. After a lumpectomy or mastectomy, an innovative technique which has been implemented is performing this fat grafting and transfer technique to completely reconstruct a breast. This would involve no other scars or incisions, no foreign bodies or implants, and no complex flap procedures. Plus, additional benefits to the breast reconstruction include as close to normal sensation of the breasts along with the benefit of liposuction to harvest the fat from wherever there is spare fat! Working with your breast surgeon during the oncologic procedure for your breast, some fat is harvested during the same surgery, which in turn is placed back into the breast area. This will give a small breast mound immediately after the procedure. An external expander device is then used for several weeks after the initial procedure while you are sleeping. The expander will have the same befits as the internal tissue expander, owever it is simply worn on the outside as a vest, without having an implanted prosthetic. It has been shown to increase vascualrity, increase blood supply (important for radiated breasts especially), as well as expand the breast framework for which the fat will be placed in the future. Once adequate expansion has been obtained after several weeks of wearing the external expander vest, a simple outpatient procedure will be performed in which liposuction will be performed from areas where you have excess fat. Instead of wasting this fat, it will be harvested, washed, and then transferred back directly into the breast to give the additional volume to reconstruct the breast. The liposuction may be performed from the abdomen, flanks, hips, thighs, buttocks, etc., until enough fat has been obtained to give adequate volume for your reconstructed breast. Multiple micro-fat grafts will then be placed throughout the expanded breast framework within its well-vascularized bed. Sometimes this will take a few small outpatient procedures, separated by several weeks, to obtain the results. Fat grafting allows precise placement of where the fat should go in order to perfectly contour the breast shape. The newly-reconstructed breast mound has now been recreated with the use of only your own fat via liposuction with the hopes for a breast mound that looks and feels much like a "normal" breast. The results thus far have been superb and patients have raved about their overall results. Have a discussion about ALL options available for breast reconstruction with your plastic surgeon, and together, decide which breast reconstruction technique is best for you.

Your question is a very good one. Breast reconstruction after mastectomy is giving better results than ever before but it is not uncommon to have contour issues such as a depression or sunken area around the edges of the implant. Fat grafting is very helpful for this.

Upper pole hollowing is a very common problem after implant based breast reconstruction.  Improvement in this area can generally be achieved with fat grafting.  The fat used is generally harvested from your abdomen and flanks by liposuction and then injected to fill the hollowed areas.  Most patients are very happy with the results!

It is very common to have upper pole hollowing after placement of an implant for breast reconstruction. The reason it that most current implants are round while the breast is not. There is a tail of the breast that extends upwoard toward the collar bone. Fat grafting is a great way to repair that defect. We currently use it on selected patients who have good results but are looking for a more natural appearance. The benefits of fat grafting is the short downtime, and MANY of our patients like to have some fat taken out of the belly and put in th breast.

You have several options to correct/improve the hollowing that you describe.   First, why are you likely experiencing this hollowing?  Without an examination, I would suggest that the skin envelope is likely a bit larger than the implant used.  So one option to improve this is to go with a larger silicone gel implant.  Another option would be to consider the form-stable "ultra-cohesive" silicone gel implants (ie. Allergan 410 or Mentor CPG implants) - but these are only available in an investigation study.   Another option as my colleagues suggest is to fine tune your results with fat micrografting to "fill" in the upper pole.  Others have also advocating using acellular dermal matrices to correct this problem.   So in summary, the good news is you likely have many treatment options. Please visit with a board certiifed plastic surgeon in your area to learn more.