Fat Grafting for Full Breast Reconstruction?

Hi In 2012 I had fat grafting done with stem cells and a second one done with fat grafting alone and removal of an implant. One side of my breast is still really hard and I massage the area every day with a hand held machine for 10 minutes. It softens and then in the morning it is hard again. I am six months out. When will it fully soften?

Doctor Answers 8

Fat Necrosis

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This area of previously grafted fat may represent fat necrosis.  Fat necrosis is an area where that fat that was grafted has died and scarred (hardened).  Sometimes this area may have some fluid (liquefaction).  If there is no improvement over the next month or two then this area should be removed.


Dr. ES

Fat grafting and firmness

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Thank you for your question. During the post-operative period the breast are swollen, and the breast appears fuller and firmer. Over time they settle and soften. It may take several months for this to happen and can be encouraged with breast massage and compression. After the swelling goes down the breasts will appear smaller. I would recommend that you don't sleep on them for a couple weeks so they don't have any pressure and refrain from strenuous activities for ~4 weeks. I would follow up with your plastic surgeon who can guide you on their specific post-operative care instructions. 

If it has been over a year and you still experience localized hardness, then I would revisit your plastic surgeon who can determine if you have fat necrosis, scar tissue, or whether you should be evaluated with imaging studies.

Fat grafting for breast reconstruction

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Fat grafting is used both for correction of contour irregularity and to augment other breast reconstruction techniques. However, fat grafting alone for breast reconstruction is rarely done because significant amount of fat is used to recreate a breast. With large volume of fat injected into a small area, you are bound to have fat necrosis. The hardness on one side of your breast sounds like fat necrosis. However, physical examination or mammogram would yield a definitive answer. I recommend that you have a consultation with a board certified plastic surgeon.

Mytien Goldberg, MD, FACS
Los Angeles Plastic Surgeon

Fat grafting for full breast reconstruction?

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Hello!  Thank you for your question!  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.

The decision to have the procedure performed once again will be on you - if you are happy with the results thus far.  It is true that some of the fat does resorb (survival rate of fat grafting is 50-80%).  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.  It typically takes up to a year to see vascularization of the area, which will ameliorate some of the radiation damage present.  If the hardness is persistent, it may be some fat necrosis.  If still present after a year's time, consideration for excision may be entertained.  Hope that this helps!  Best wishes!

Fat Grafting Success Rate

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Sounds like some of the fat didn't make it.  Survival of the fat depends of the amount grafted and how healthy the location is prior to grafting.  Smaller increments tend to survive better.  If the tissue is thin and lacks adequate blood supply, it won't be able to handle large amounts of fat...which then turns hard.  It may take up to year for it to soften more, but at some point, if it doesn't soften, it may need to be removed. 

Fat grafting and hardness

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The hardness may represent fat necrosis but shoudl be evaluated to make sure it is nothing more serious.  Good luck.

Hardening after Fat Grafting to Breast

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The hardened area may represent fat necrosis (or death). Six months after the procedure, if the area remains hard it may not resolve on its own and therefore will likely need to be removed especially to avoid complicating cancer surveillance. 

Fat graft to the breast

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the hardness 6 months after fat grafting to the breast could be swelling or fat necrosis. Only by physical examination and some times mammogram we can reach an accurate diagnosis.

Samir Shureih, MD
Baltimore Plastic Surgeon

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.