Is Fat Transfer Only for Mastectomy Breast Reconstruction an Option?

I'm currently halfway through chemo for breast cancer; the plan is for bilateral mastectomy afterwards. I'm quite intrigued by the total fat transfer approach (sometimes used in conjunction w/Brava system) & would love to find someone on west coast who has experience doing this. I'm reading so many negative comments on the online discussions about tissue expanders, any kind of implants, ripples, unevenness, etc. Very unhappy women! 100% fat transfer might help avoid these issues.

Doctor Answers 8

Reconstructive breast surgery with fat grafting

This is definitely possible, and BRAVA may make your "take" even better. This cannot be done as a full immediate reconstruction, and may require multiple stages. Implants and expanders are a more traditional, tried and true approach, and to get up to more significant volumes, you may want to think about an implant paired with fat grafting. You should consult with a Board-certified plastic surgeon who performs fat grafting to the breast. On the internet the bad reports tend to outweigh the good, so you should try to get all the information you can from a plastic surgeon who performs the procedures you are interested in.

Baltimore Plastic Surgeon
4.8 out of 5 stars 50 reviews

Yes, fat grafting is possible for mastectomy reconstruction

Thank you for your question.  Yes, fat grafting or transfer has been described  for breast reconstruction at the time of mastectomy.  I am very familiar and trained in this technique.  I do not know any surgeons doing it on the West Coast but that doesn't mean there aren's any.

If you do not want implants you may be a candidate for microvascular tissue transfer from your tummy, inner thigh, upper or lower buttock, and sometimes skin/fat with muscle sparing from your back.  It depends on what "donor site" would suit you best.

Here is web reference that contains additional information regarding fat transfer with the BRAVA system.  I hope this helps.


J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Use of fat transfer in breast reconstruction

In my practise, fat transfer has become an invariable adjunct to postmastectomy breast reconstruction.  The primary applications include the reduction of rippling following implant reconstruction,  upper pole augmentation following implant reconstruction, and following flap reconstruction.  I have used it as the primary modality for the postmastectomy patient, but in highly selected cases. Bear in mind that there are downsides to practically all types of breast reconstruction, including fat transfer.  Foremost among these is the unpredictable nature of the technique, the need for more than one operation, and the possiblity of oil cyst formation.  

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Your pictures would be helpful and are you going to need radiation tx

The use of fat grafting is another option that may or may not be the best option for you. The use of DIEP flap for immediate reconstruction post nipple sparing mastectomy would give the best cosmetic result. You breast shape,possible need for radiation tx and your body fat content are other factors. Please send more information.  

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Breast reconstruction with fat is an excellent option.

I am a firm believer in breast reconstruction with fat, and have just completed bilateral mastectomy reconstruction with only fat on my own wife. On the West Coast I would recommend you consult with Dr. Joel Aronowitz in LA. BRAVA is essential for the most efficient reconstruction, allowing reconstruction in 3-4 procedures vs 7-8 procedures. My wife and I can speak first hand regarding this procedure and the BRAVA etc if you like. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

Fat transfer for breast reconstruction

I've treated a couple of mastectomy patients in a delayed fashion with BRAVA and fat grafting , no implants. Its a time consuming procedure, but can create a reasonable breast mound.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Breast reconstruction after mastectomy

Some surgeons have been employing fat grafting as an adjunct to the primary breast reconstruction that they perform.  Most are not using it as their primary form of reconstruction, because I think that it requires a lot of fat, it is not reliably incorporated, and requires multiple treatments. That being said, there are some like the designer of the BRAVA system who believes that the system enhances "take" of the fat. This is still being investigated.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Fat Grafting for primary breast reconstruction

I find fat grafting to be a wonderful tool to further refine and reshape a tissue flap (diep/gap/tram) or implant breast reconstruction.   I do not use fat grafting with Brava as a primary method to reconstruct the breast, as it typically requires several more stages than traditional reconstruction.   In regards to negative comments to tissue expanders and implants, I think you will find unhappy and very satisfied patient reviews on almost all breast reconstruction procedures.    My concern is that primary breast reconstruction with fat grafting alone is a relatively new technique that has not passed the hands of time.    Tissue expander or tissue flap breast reconstruction has been extensively studied in the plastic surgery literature and proven to deliver satisfactory short and long term results.  I wish you a safe and healthy recovery.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 86 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.