Fat Grafting to Breasts to Treat Post Mastectomy Pain?

I had a BMX 5/2012 and am still having pain and tightness. Tssue expanders exchanged to gel implants 11/2012. No rads or chemo, but right capsule released in Feb due to scar tissue. Still have constant tightness and nerve pain being treated with Lyrica but the side effects are bad. My question is about using stem cell fat transfer to reduce or eliminate my pain. Is it possible to get pain relief with fat injected around the incisions and/or over the entire breast mound without removing the implants?

Doctor Answers 6

Fat Grafting to Treat Mastectomy Pain #breastcancer

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Thank you for your question. Firstly congratulations on being a survivor. You are an inspiration to us all. I reconstruct many women here in Arizona. Reconstruction is challenging at best. It is a good thing that we do not have to contend with radiation because it can make things so much worse. It sounds like maybe you had a capsular contracture and had to have some of the scarred capsule removed. You can have recurrent contractures and if that happens I usually use one of the biologic skin products that we use to help prevent contractures. Your question about fat transfer is such a good one. There is so much literature surrounding using fat transfer and how the effects from the large concentration of stem cells found in fat helps to improve the quality feel of tissue especially in radiated breasts. I would have to see you but yes, fat transfer can help. There is no guarantee, but it can help and I use it all the time in my breast reconstruction patients.

Fat transfers can be useful adjunct in reconstruction

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Thanks for your question. Postoperative tightness in this scenario can be from the pocket being small relative to the implant, the capsule itself being tight as in a contracture, or the skin itself being noncompliant and tight. One of the added benefits of using the acellular dermal matrices is the decreased scar tissue that is formed. You did not mention if this had been done primarily, but certainly would be worth considering. Since you didn't have radiation, it is unlikely the envelope itself is affected. The final consideration could be downsizing the implant. Fat grafting itself is more for contour depressions. Oftentimes there is a small space between the skin and capsule where fat can be placed. I use it frequently to enhance the contour and improve symmetry. I would be reluctant to promise anyone that it would help with pain. Best of Luck!

Fat grafting for pain post mastectomy.

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Fat grafting and stem cell transfer in this type of situation can only be considered experimental .

Anecdotally fat transfer after post mastectomy and radiation skin changes has produced improvement in skin quality and local comfort.

I have treated one patient who presented with scar pain post mastectomy with fat transfer with good resolution of her pain.

I wouldn't write off fat transfer as a possible treatment. It mightn't work but on the other hand it might just help. There's not a lot to lose by undergoing a fat transfer. It's something you should discuss with a sympathetic Plastic Surgeon who can explain the pro's and con's to you. It may be better than undergoing pain management protocols and taking lots of analgesics.

Douglas McManamny, MBBS, FRACS
Melbourne Plastic Surgeon

Breast pain after breast reconstruction

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I would see no benefit for fat injections in this situation.  Pain can be quite elusive.  If your breast is tight then this is a likely source for your pain.  You should be seen by your plastic surgeon if your pain persists.  

Fat transfer

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Fat can be injected in the presence of an implant. It has to be done by experienced surgeon and very carefully. Still there is a danger of puncturing the implant. There is no scientific evidence that fat transfer will improve nerve pain.  It is better to work with a pain management team for that type of pain.

Samir Shureih, MD
Baltimore Plastic Surgeon

Fat grafting to breasts to treat post-mastectomy pain?

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Hello!  Thank you for your question!  Given the pain that you are describing, you may be developing/have developed a capsular contracture, which is scarring around your implant.  This typically does not resolve with any modality besides surgical excision.  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.

If the pain does not resolve despite these efforts.  You may consider a flap reconstruction, such as the DIEP flap.  Hope that this helps!  Best wishes!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.