Is Fat Grafting The Right Choice For My Breast Reconstruction?

On Sept 28 2011 I had a DIEP Flap procedure performed. I had a bi-lateral Mastectomy due to breast cancer. Underwent Chemo and Radiation. After the DIEP Flap procedure my Dr told me that I needed two sessions of fat grafting. I have read that your body can reabsorb the fat. I am on the thin side to begin with and dont have alot of fat to work with so am wondering if fat grafting does not work if a implant can be put in? My right breast has a hard lump I was told its fat necrosis and will go away

Doctor Answers 8

Is fat grafting the right choice for my 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.  Hope that this helps!  Best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Fat grafting is a great way to refine breast reconstruction results

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Fat grafting is an ideal way to use your own tissue to improve the breast reconstruction result.  The breast reconstruction with a flap due to the shape of the flap doesn't completely reconstruct the breast to the previous size and shape.  Using small amounts of fat graft removed from the abdomen, thighs, of other areas can significantly improve the size and shape of the breast reconstruction result to better match the native breast.

Fat grafting for revision reconstruction

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Yes, fat grafting is an accepted technique and can improve the contour of your breast.  Yes, some of that fat may be resorbed and you may need more than one session.

You may also ask your surgeon if you are a candidate for an implant.  Both implants and fat grafting can be more difficult on the side of radiation because the implant has a higher chance of developing a hard and/or painful scar and if you have poorer circulation from radiation, not as much fat may successfully survive.

Also, if you do indeed have fat necrosis, it may or may not soften and go away over time.

Discuss these details with your surgeon. Best of Luck.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

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Is Fat Grafting The Right Choice For My Breast Reconstruction?

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Fat grafting in breast reconstruction is a newer reconstructive option. There are very few surgeons offering this technique. Best is to see one. I think it is just beginning to be accepted. I use the "layering technique" of Dr Syd Coleman. 

Fat Grafting Can Improve Shape and Size

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Fat grafting can improve shape, contour irregularities and fullness of the breast after reconstruction.  Unfortunately not all of the grafted fat will survive and some will reabsorb.  Even with overcorrection it is common to have to repeat fat grafting.  It sounds as if your doctor has offered a very reasonable plan, and I would not rush to have an implant placed.  



Jeremiah Redstone, MD
New York Plastic Surgeon
4.7 out of 5 stars 13 reviews

Fat grafting and breast reconstruction

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Fat grafting is used commonly in breast reconstruction to improve the look of the breasts and to correct minor deformities. Its use in cosmetics surgery is gaining popularity but still in its early phases and long term results are been evaluated. The concept of having a flap reconstruction with a DIEP flap is to use your own tissue and avoid the need for implants!!! But if needed it is possible to place implants later (6 months or longer after the reconstruction with the flap !

Good Luck!!!!

Is fat grafting for breast reconstrucion effective?

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Fat grafting is a powerful tool in breast reconstruction. Even in thin patients, a good amount of fat can be obtained for grafting. It is ideal for shaping and enlarging in both breast reconstruction and breast cosmetic procedures. The amount of fat survival ranges between 50-80 percent. Implants can also be placed after a TRAM or DIEP reconstruction, but would wait at least 6-12 months before proceding.

Fat grafting after breast reconstruction

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Fat grafting can sometimes help fill areas that the flap could not. This helps with overall contour, but because fat grafting does not take 100% this often has to be repeated.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.