After breast reconstruction I want my implants removed and do fat grafting/transfer. Can this happen in one surgery?

Question

I am 47 years old and had a double mastectomy 4 years ago. I had immediate nipple sparing reconstruction with aloderm and silicone implants. Looks good, but they are uncomfortable and painful after workouts. I would like to get the implants removed and have fat grafting/transfer treatments to rebuild my breasts. Can this be done in one surgery? Would I need to use the brava even if there is room from the implants? Does the fat go over or under the pec muscle? Don't want to do a flap surgery.

Jeffrey E. Schreiber, MD, FACS · Answer

I have successfully done fat grafting to the breasts for cosmetic and for reconstructive purposes.  The aesthetic results depend upon the quality of the skin and on the amount of fat that you have available.  It's hard to give you and exact result without seeing you first, but during consultation we could review the entire procedure and I could let you know the results that you could expect.Thank you for your question!Dr. Schreiber, Baltimore plastic surgeon

Ajaya Kashyap, MD · Answer

Thank you for your question.The two procedures can not be done at the same time as the Fat Grafts will not "take" because of the dead space created after Breast Implant removal. Fat grafting can be done later on and you will probably require several sessions. Even so you are unlikely to get the kind of volume that the implants have given to your breasts. You will need to see an experienced Plastic Surgeon who does these procedure routinely to discuss your options.All The Best !

George Marosan, MD · Answer

Without photos and the limited information given ( height? Weight?), only general comments can be made. Fat needs to be placed in small string like strands in the tissues. One cannot inject fat in the implant pocket after implant removal, because that fat will coalesce into a lake of fat which will die due to lack of blood supply. You might not have enough donor fat to transfer(?). See a board certified plastic surgeon with experience in fat transfer to the breasts for a consultation to see if you are a candidate for this procedure. This will require removal of your implants first (I would not be concerned about excess loose skin at this time), allowing the implant pocket to collapse and heal. Then, you will need serial fat grafts or the BRAVA system and serial fat grafting. Although this sounds like a desirable option, but it might not be for you.

Kenneth R. Francis, MD, FACS · Answer

Dear Brewog,The scenario that you request cannot be provided in one setting.  The space created by your implants is not the same as space created by a Brava device.  It is dead space into which fat cannot be injected or it will die.  Your surgery would need to be staged with removal of the implants and capsules first, followed by first stage fat transfer 3-6 months later.  Also, it may take several stages of fat transfer to create a sizable enough breast.  Good luck!

Steven Wallach, MD · Answer

fat grafting to the breast is often done in stages because many times one treatment will not be enough.  removing implants will leave a large "dead space" and it probably isn't recommended to do fat grafting at the same time.  There are other autogenous tissue reconstructions if you are interested and a candidate.

William A. Terranova, MD (retired) · Answer

I am sorry that you are having trouble with your implants.  There is a lot to answer here.  Yes you can have removal of your implants.  And yes you can have fat grafting.  But you will not be able to gain enough volume in one surgery.  And then you would have to consider what would happen to all that suddenly redundant skin envelope that results from implant removal and inability to fill that envelope with fat.  It will wrinkle significantly and would require tissue expansion to correct.  You are much better off with flap surgery.But have you considered simpler options?  Have you tried modifying your workout regimen so that you are not doing heavy chest work?  You will be best served by consulting a board certified plastic surgeon.  What about the surgeon who did your reconstruction?Good luck

After breast reconstruction I want my implants removed and do fat grafting/transfer. Can this happen in one surgery?

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