Considering a breast fat transfer: Are microcalcifications unavoidable over time?

Question

I've had an explant and am considering getting a breast fat transfer. I'm 50. I've seen sequential mammograms, and it seems unavoidable that the microcalcifications steadily worsen over 10 years, making it harder to detect breast cancer. Am I correct in this - i.e. will microcalcifications from fat necrosis steadily worsen over time? Will lumps worsen over time? Is this risk mitigated by minimizing fat transfer (e.g. to only 50 cc to address explant issues)?

Kenneth Hughes, MD · Answer

Radiologists have confirmed that any calcifications caused by fat grafting can be distinguished from any calcifications associated with malignancy.  Therefore, this triumph has overcome the concern that fat grafting could possibly lead to more biopsies secondary to mammographic calcifications.  In addition, breast fat transfer has not been shown to increase breast cancer risk.

Brian Bassiri-Tehrani, MD · Answer

This is a very thoughtful question. This topic is somewhat controversial. Our understanding of fat grafting and our imaging techniques/interpretation have evolved in a short period of time. About 15 years ago, fat grafting was a hot topic because of the confusion it caused in breast imaging like mammograms. However, there has been a better understanding of the characteristics of fat necrosis versus malignant or pre-malignant micro calcifications. With improvements in imaging, radiologists generally can interpret micro-calcifications that are worrisome from overt calcifications from fat necrosis.
Overall, recent literature shows that fat grafting does not increase the chance of developing a new breast cancer, or accelerate the return of a previously detected and treated breast cancer. Continued mammograms and surveillance is important to monitor any changes in the characteristics of breast tissue over time, regardless of your decision to move forward with fat grafting or not.

Daniel Barrett, MD · Answer

Dear RAE10,
fat transfer breast augmentation is a viable alternative for women who desire larger breasts without the use of implants. Fat transfer is also widely used in reconstruction of the breast after a mastectomy or lumpectomy. It can also be very effective in correcting the size and shape of the breasts due to genetic problems such as tuberous breast or Poland Syndrome, two conditions that look like misshapen or underdeveloped breasts.In addition, the following scenarios are also reason to consider breast fat grafting:• If you have chest areas that appear creased and sunken• If you desire more permanent correction than is provided by temporary fillers• If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate the natural curve of your breasts• To fill in contour irregularities or hide obvious signs of breast implantsYou should discuss your concerns with a board certified plastic surgeon and make sure your surgeon understands your concerns and your breast augmentation goals. 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

Zoran Potparic, MD · Answer

Breast fat transfer was the first area where fat grafts were used. Concerns about fat related calcifications and breast cancer related calcification was the reason that fat grafting of the breasts was not practiced for many years. However, radiologyst now have ability to distinguish malignancy related calcifications(micro) from those fat related (macro) and fat grafting is now vey common adjunct to breast reconstruction after mastectormy. In our experience, an average of 150-250 ml of fat grafts per stage (usually in 2 stages in smaller breasts) may be needed to correct shape and volume of breast after explantation. Breast lift is frequently performed in these cases. Hope this helps.

Gerald Minniti, MD, FACS · Answer

Surgical procedures of the breast, including fat grafting, produces MACROcalcifications. They represent fatty tissue that has been injured or deprived of circulation, leading to necrosis. Calcification of part of the necrotic tissue can occur. It does not increase as the years pass. Breast cancer creates MICROcalcifications. In 2006 the American Society of Plastic Surgeons made a statement that fat grafting the breasts produces similar macrocalcifications as other breast procedures and that it does not represent an impediment to reading mammograms greater than any other breast surgery procedure.

Randal Haworth, MD, FACS · Answer

Microcalcifications can occur due to a variety of reasons, including breast surgery, trauma, and breast cancer. The appearance and progression of microcalcifications can vary depending on the underlying cause, but they are typically monitored closely by mammograms to ensure early detection of any changes.

Fat necrosis is a condition that can occur when fatty tissue in the breast is damaged or dies, leading to the formation of small lumps or areas of hardness in the breast. This can be a common occurrence after breast surgery, including explant surgery and fat transfer procedures.

The risk of microcalcifications and fat necrosis after a fat transfer procedure is generally low, but it is not completely eliminated. The amount of fat transferred can affect the likelihood of developing these conditions, with larger transfers increasing the risk. Minimizing the amount of fat transferred, as you suggested, may help to mitigate this risk.

It's important to discuss the potential risks and benefits of a breast fat transfer procedure with a board-certified plastic surgeon, particularly if you have a history of breast cancer or other breast conditions. Your surgeon can evaluate your individual situation and recommend the most appropriate treatment plan for you. Additionally, regular follow-up with mammograms and breast exams can help to monitor any changes in the breast tissue over time.

Best of luck !

Hilton Becker, MD · Answer

Fat grafting to the breasts can cause microcalcifications over time 
It is therefore preferable to inject smaller volumes of fat over a few procedures.

Connie Hiers, MD, FACS · Answer

Once the fat transfer has healed, the risk of macrocalcifications in the fat is low.  Early in the healing process is when care must be taken to avoid too much trauma to the new fat.

Mats Hagstrom, MD (license on probation) · Answer

Microcalcifications due to breast fat transfer have a different appearance than those related to breast cancer. To date radiologist have not shown concern in missing a breast cancers due to previous breast fat transfer.
The procedure will change your mammogram, and these changes should be stable and not change after the first six months.
Feta transfer is a pretty subtle procedure, and it may not deliver the type of results you’re hoping for. Fat transfer is not good at changing the shape of the breast and most likely that’s what you’re trying to achieve.
Fat transfer can at the best increase breast size by 1/2 cup when done correctly by a sufficiently experienced surgeon. The procedure is not good for altering breast shape, unlike implants.
Grafting 50 mL of fat, seems like a pointless exercise. I typically graft 10 times that volume on someone with moderate to small breast size and from that obtain 1/2 cup increase as a final result.
Best,
Mats Hagstrom, MD

Considering a breast fat transfer: Are microcalcifications unavoidable over time?

Answers (9)

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