Can fat transfer techniques be successfully applied for breast reconstruction? Or are there better methods out there?
What is Lipofilling and How is It Used for Breast Reconstruction?
Doctor Answers 21
Fat transfer techniques can aid breast reconstruction
Fat transfer is a useful tool to optimize breast reconstruction outcomes. I recently fat grafted a patient's TRAM flap to improve volume, projection and shaping of the reconstructed breast. Insurance will pay for 'revision of breast reconstruction' and patients benefit from the liposuction required to obtain the fat for grafting. That's a double bonus for the patient !
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Fat grafting has been shown to be a reasonable ancillary procedure to "touch-up" monor irregularities with breast reconstruction.
Fat grafting in breast 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.
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Fat grafting and breast reconstruction
in general, fat grafting (removing fat from one area of the body and injecting into the reconstructed breast) is used to fill-in or refine areas of the reconstructed breast.
Fat transfer great for breast reconstruction
Fat transfer can be really useful in breast reconstruction for some patients. Obviously it is not possible to use fat transfer as the only means of reconstruction. Fat transfer is most useful for filling in smaller asymmetries that may still exist following your reconstruction procedures.
Fat transfer or lipofilling and breast reconstruction
Recently advances have been made in techniques to harvest and transfer living fat cells from patients and move them from one part of the body to another. Improving contour issues in breast reconstruction is one situation that fat transfer has an increasingly important role.
Most commonly, fat transfer is used to soften the interface between the edge of the implant and the surrounding tissues. Sometimes, the extent of the mastectomy is beyond where the implant will fill and a sharp stepoff is noted. Fat can be harvested from one part of the body (such as the abdomen, flanks, hips, or thighs) and prepared in such a way as to preserve the most living fat cells. These are then immediately injected into the tissues using special instrumentation that allows the fat to be deposited in small streams to increase the likelihood that the blood supply will grow into the fat tissue.
Sometimes, fat transfer can be used to increase the size of an autologous reconstruction (such as a TRAM flap or DIEP flap), or to correct localized contour deformities.
The use of fat transfer to correct post lumpectomy deformities, to enhance then size of a normal breast without using implants, or to creaste a breast mound without any additional need for tissue transfer or implants are exciting new frontiers that are currently being evaluated.
Fat grafting in breast reconstruction
Fat grafting is often used in breast reconstruction for two main reasons -
- To correct the "shelf" that occurs between the chest wall and the upper pole of the implant
- To correct contour irregularities around the implant (palpable ripples, thin areas of skin, etc.)
The fat is removed from another area of your body (abdomen, thighs, hips) and is processed to isolate the fat cells. These fat cells are then injected into the area you wish to fill. Depending on technique, a percentage (the higher the better) of this transplanted fat will "take" or live and thus correct the deformity. Sometimes, more than one surgery is required to correct an area.
Some insurance companies deem this procedure as "investigational" and will not pay for it. It is important to discuss this with your surgeon prior to undergoing fat transfer. Other options include using dermal fat grafts (leaving fat attached to skin and transplanting as a single unit) and dermal matrices such as Alloderm.
Lipofilling or fat transfer can be very useful in breast reconstruction.
Fat transfer is not the primary technique in breast recostruction, but we often use it to add finesse and a more natural look AROUND the main reconstruction.
The main breast reconstruction is done with an implant or a flap. But there can be hollows or defects from the mastectomy around the implant or the flap. This is where filling in with fat injections can turn a good result into a great result.
The use fat grafting in breast reconstruction
I have also used fat grafting to correct contour deformity after lumpectomy and radiation. However, the use of fat grafting as a primary breast reconstruction technique after mastectomy has been reported but if limited successful result.
I recommend to all patients with breast cancer to work closely with all their doctors including oncologist, oncologic breast surgeon, and board certified plastic surgeon to plan out their breast reconstruction.