Would I necessarily get necrosis again if I filled the indent with more fat? (Photo)

Question

I had fat transfer to my breasts and now I have this ugly hard lump, about the size of a strawberry that sticks out from my breast and makes me look and feel deformed. I told my surgeon about it and he will remove it but says I could likely be left with an indent which he will not fix with more fat transfer for fear of more necrosis. His solution is a donut breast lift which raises red flags for me. Would I necessarily get necrosis again if I filled the indent with more fat?

Daniel Barrett, MD · Answer

Dear swilliams123,
fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Peter D. Geldner, MD · Answer

Sadly, fat transfer can result in some fat necrosis. On occasion, it may resolve by itself within a few months. If it is persistent, it may be treated with liposuction or resection. Allowing several months to heal, assuming the remaining tissue is healthy, fat can be transferred to treat any remaining defect. As far as the recommendation for a donut mastopexy, your surgeon might be right. But it shouldn't have much to do with the prior fat transfer. Ask them for their reasoning.

Connie Hiers, MD, FACS · Answer

Your one photo does not show your whole breast so it is difficult to comment. However, removing the area of fat necrosis may be all that you need since it does stick out now. Later, if a dent forms, you could consider Sculptra injections to help build in the tissue.

Douglas Taranow, DO, FACOS · Answer

It is impossible to say that excising the mass and filling the void with new fat would have the same issues or whether this would work.  It's a gamble like all procedures.  Certainly worth a try though.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

The chance of having indentation depends on the size of the mass that’s removed and also how much breast tissue you have. For example, if you have breast implants and the layer of breast tissue is quite thin, then removing the area of fat necrosis, may leave and defect. Fat transfer can be successful. Without fat necrosis if good technique is used. There are several variables that need to be addressed. In order for fat transfer to be a viable procedure. One of them is having sufficient host tissue to support the grafted fat. Necrosis happens when the ratio of grafted fat to host tissue is not maintained properly and too much fat is placed in a single area. 
Consider getting in person second opinion consultations if you have concerns about the competency of your provider.
Best,
Mats Hagstrom, MD

Would I necessarily get necrosis again if I filled the indent with more fat? (Photo)

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