Fat Transfer to Even out Breasts After Lumpectomy?

Question

I am a 40-year-old woman with a lean athletic build. I went through a lumpectomy in 2005 due to a tiny, grade 3 cancer found. I had chemo and radio and now I'm considering fat transfer to even up my breasts (one is now an A cup where it was previously a B cup). I have yearly MRI scans and am healthy and well, but worry that my body (legs, butt) will become scared and lumpy from this procedure. I am of Caribbean origin. Any advice?

Ricardo L. Rodriguez, MD · Answer

I strongly recommend that you find somebody who is VERY well experienced in fat grafting, because individual surgeon expertise has a lot to do with results.
I have done a lot of fat grafting in my time, but like Dr. Placik, I was very hesitant to try it on breast tissue, much less irradiate ttissue. This changed when a landmark article by a group in Italy was published in the American Journal of Plastic Surgery in 2007. Several patients with varying degrees of radiation damage were treated successfully.
I myself have done it on a few patients, and I have been surprised how well the irradiated tissue responds.
The theory is that the stem cells present in the fat tissues actually work to repair the irradiated tissue.
Check out the link below for more info on stem cells.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Thanks for your question. Depending on how much donor fat you have available, this may be a good option for you. You can have contour changes at the donor site (typically I would use the loin / love handle area to minimise this risk), but the risk is low if your surgeon is experienced in the technique. You would have some very small incisions at the donor site to enable fat harvest. If you are darker skinned then you are at increased risk of hypertrophic / keloid scarring, but if this did not occur following your lumpectomy then the risk will be low. Consult a plastic surgeon with significant experience of breast reconstruction. Good luck!

Lewis Albert Andres, MD · Answer

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.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.

Trevor M. Born, MD · Answer

Dear Gi
Micro Fat Transfer to the breasts has become more common in the Cosmetic Surgery practice.  I have been doing this for 7 years. The grafted fat helps with the contour and can reverse the changes due to irradiation injury.  i have seen complete clinical reversal of the radiation damage and this has been reported by many surgeons with large volumes of clinical experience- Riggotti, Coleman
The area from where the fat is harvested should have a pleasing contour- no resultant deformity!  
The procedure can be repeated if necessary- 1/5 patients needs a touch up.
With Warm Regards,
Trevor M Born MD

Otto Joseph Placik, MD · Answer

Your concerns are valid and the risks of lipoinjection (fat grafting via injection) are related to the donor site and/or the recipient site.
Irregualrities at the donor site can occur. Radiation may also increase the risks of failure of the fat to survive and "take". Furthermore, although it was controversial in the past, fat injection to the breasts has only recently been discussed as an option. Most likely, your history of radiation puts you at a higher risk of complications.

Morgan E. Norris, III, MD, FACS · Answer

Congratulations on being a survivor!  I have had success using the fat transfer
process in my breast reconstruction patients to correct depressions after
lumpectomies.  Without a physical exam it
is difficult to say if a fat transfer would add enough volume back into your
breast to improve the symmetry of your breasts.  Now, with any surgery where an incision is made in the skin there will
be scarring of some kind.  The good news
is liposuction incisions are fairly small and so the chance of noticeable
scarring is minimal but it can still happen with some patients.  Lumpiness is also a possible side effect of
liposuction of the legs and buttocks that can’t always be prevented.  I recommend researching only board certified
plastic surgeons that work with breast cancer survivors and then schedule a
consultation to discuss your options.Be well and good luck!@norrisplastic

Steven Wallach, MD · Answer

There are many options for breast reconstruction including tissue exapnders and implants, latissimus flaps with implants, fat grafting for small contour problems, TRAM flaps, DIEP flaps, SGAP, and IGAP flaps to name a few. You require an exam first to figrue out what is best for you..

Fat Transfer to Even out Breasts After Lumpectomy?

Answers (7)

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