Large lump after breast fat transfer - what is the best course of action for this?

Question

3 months after my breast fat transfer, I noticed a large, firm lump in one of my breasts. 5 months post-op, my surgeon attempted to drain it while doing a second fat transfer (the first one didn't take). I am now almost 7 months post op (from my initial procedure) and one month after my 2nd procedure. The lump is still there, and it is now painful anytime I move my arm a certain way. Will massaging it help? If not, what would be the best course of action to take for this?

Daniel Barrett, MD · Answer

Dear Lisa172,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

This is one of the problems with fat transfer. The breast getting lumpy. It should improve with time but I also think you should consider getting a mammogram to be on the safe side

Bryan Curtis, MD · Answer

A large lump following breast fat transfer could potentially indicate several issues, including the formation of a seroma (accumulation of fluid), hematoma (collection of blood), or adipose tissue necrosis (death of transferred fat cells). Here's a recommended course of action:1. Consultation with the Surgeon: The first step should be to contact the plastic surgeon who performed the fat transfer procedure. They will be familiar with your medical history, the specifics of the surgery, and any potential complications that may have arisen. They can provide the most accurate assessment and guidance based on their expertise.2. Physical Examination and Imaging: The plastic surgeon may conduct a physical examination to assess the lump and may recommend imaging studies such as ultrasound, MRI, or mammography to further evaluate the area. These imaging studies can help determine the nature and extent of the lump.3. Treatment Plan: Depending on the cause of the lump, the plastic surgeon may recommend different treatment options:• If it's determined to be a seroma or hematoma, drainage may be necessary to remove the accumulated fluid or blood.• If adipose tissue necrosis is suspected, the lump may resolve on its own over time as the body reabsorbs the dead fat cells. In some cases, the plastic surgeon may recommend massage or other techniques to aid in the resolution of the lump.• In rare cases where there are concerns about infection or other complications, surgical intervention may be necessary to address the issue.4. Follow-Up: It's important to follow the plastic surgeon's recommendations for post-treatment care and attend any follow-up appointments to monitor the healing process. This allows for early detection of any complications and ensures proper management.5. Patience and Monitoring: Recovery from complications following breast fat transfer can take time, and it's essential to be patient and allow the body to heal. Keep the plastic surgeon informed of any changes or concerns during the recovery process.Overall, prompt communication with the plastic surgeon and adherence to their recommendations are crucial for addressing and resolving any issues that may arise following breast fat transfer surgery.

Connie Hiers, MD, FACS · Answer

I would first get an ultrasound or mammogram to make sure this is fat necrosis and nothing else. Then, it may need to be surgically removed since if it is fat necrosis which is not liquid. Otherwise, you can keep it and keep an eye on the area that nothing else pops up near it.

Darryl J. Blinski, MD · Answer

Your discussion without photos is a common complication following that transfer to breast done in two lumpy of injection pattern. Ultrasound mammogram required and possible surgical. Excision of this fat cyst. Lump with pathologic. Diagnosis is required. Please see your surgeon or seek other opinions, virtual contents also also available.

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality, liposuction and fat trans results is more difficult than most people realize.
The number of plastic surgeons have truly mastered. These procedures is relatively small.
Breast fat transfer can consistently deliver 50% volume increase when done correctly by sufficiently experience provider.
Having zero take typically indicates a provider is lacking in skill and experience.
Developing, palpable or symptomatic fat necrosis is a sign of poor technique with a provider putting too much fat in a single area.
Grafting successfully requires grafting diffusely with sufficient surrounding host tissue to support the graft.
Removing symptomatic fat necrosis can be challenging and typically requires an open excision.
Follow up with your provider or scheduling person second opinion consultations with other plastic surgeons in your community.
For those considering breast fat transfer, I cannot emphasize enough the importance of provider, selection, and properly vetting providers before having this procedure.
I suggest patience do that by having multiple in person consultations before selecting a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who have similar body characteristics to your own.
 an experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
When viewing fat transfer results recognize that early results can look very impressive but do not in anyway represent final long-term results.
Never assume that fat transfer results are final unless you know the timeframe of when after pictures were taken in relationship to the date of surgery.
In order for after pictures to be representative of final results they should be taken no sooner than three months.
Being shown a handful of pre-selected images, representing only the best results of a provider’s career may be insufficient to get a clear understanding of what average results look like in the hands of that provider, what your results are likely to look like or how many of these procedures they’ve actually done.
Likewise, not having a clear understanding of the timeframe of when after pictures were taken, can give false expectations of what the procedure can or cannot deliver.
 Fat transfer can consistently give patience about 1/2 cup increase in breast size or about 50% total increase in breast volume.
This tends to be very consistent when done by providers who have sufficient experience.
Those who mastered the procedure rarely have patience who don’t have graft.
 my experiences been that once the procedure has been mastered fat transfer results for breast antibiotics becomes quite consistent.
What is inconsistent is plastic surgeons ability to master the procedure.
There’s no correct number of consultations needed to find the right provider.
Considering how few plastic surgeons have actually mastered both Liposuction and fat transfer I recommend patience schedule at least 5 to 6 consultations before considering scheduling surgery.
The learning curve for this procedure is far steeper and far higher than most people realize including most plastic surgeons.
Best,
Mats Hagstrom, MD

George Lefkovits, MD - Account Suspended · Answer

I am not surprised that draining the lump didn't help because these lumps after fat transfer are usually masses of fibrous scar tissue. They may improve with time ( although not a high probability). Injection of steroids into the mass may help. And, sometimes actual surgical removal may be necessary. You should discuss this with your plastic surgeon. Good luck!

Large lump after breast fat transfer - what is the best course of action for this?

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