What Are my Options for Filling an Indentation Left After Lumpectomy?

Breast reconstruction after lumpectomy is becoming increasing common as breast conservation in the face of breast cancer becomes more sophisticated. Many times lumpectomy defects can be very challenging to reconstruct.
The first issue involves whether you have had radiation. Irradiated breasts are more common in people who have had lumpectomies and make reconstruction more complicated.
Typically radiation will require the usage of "autologous" tissue (meaning your own). The benefit of this tissue is in this situation it would typically be taken from an area outside of the field of radiation and would not have radiation issues. Many times patients who have had radiation will also require some amount of skin on the tissue that is transported. The tissue that can be used includes lat. dorsi (back skin and muscle) or microsurgical breast reconstruction techniques including DIEP, SIEA or SGAP. All these letters stand for different microsurgical flaps that are commonly used for breast reconstruction.
If you haven't had radiation local tissue rearrangement or custom implants might be used for reconstruction.
In addition fat transfer can be very useful for filling in small defects with the qualification being sometimes the scarring can create calcifications that make breast cancer more complicated.
Typically injectables or alloderm alone would be an inappropriate choice for breast reconstruction, especially in a patient that had received radiation.
I hope this helps!
Steve Williams, MD

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.

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.

The most important component in the decision making is whether you have undergone or will undergo radiation therapy. Radiation may affect your current breast implant and may further compromise your candidacy to undergo reconstruction with a prosthesis (tissue expander or implant).
Depending on the amount of radiation received, you may be a candidate for breast reconstruction using your own tissue. Examples of these muscle flaps include the rectus muscle and latissimus muscle.
Recently, a lot of attention is being placed on the latissimus muscle as a suitable option for breast conservation reconstruction. Refer to www.pubmed.org for references to these articles about the latissimus muscle.

Depending on the degree of the deformity, there are several options including utilizing local tissue rearrangement with or without additional tissue which may include the use of a dermal implant such as Alloderm, replacement or revision of your implant reconstruction, and finally the use of autologous (your own body) tissue from another site such as your back or abdominal areas. A consultation with a Plastic Surgeon is the best place to start.

Thanks for your question. There are a number of options for dealing with contour irregularities after lumpectomy. 
Commonly, fat grafting can be performed to fill up the indentation. This is a simple procedure where fat is taken from one part of the body and then injected into area where it is required. Some plastic surgeons are concerned that the fat grafting may promote tumour growth but recent large reviews have not demonstrated any increased incidence of tumours in patients treated with fat grafting.
If a lot of tissue is required, you may benefit from having a "flap" of tissue moved into the area. For lumpectomy defects, often the flap used in taken from the back (the latissimus dorsi muscle with skin and fat).
If the irregularity is due to implant malposition or capsular contracture, you may benefit from revisional surgery with or without the use of sheets of acellular dermal matrix (donated skin that has been specially treated and which is useful when dealing with implant related problems).
I hope this helps.

If you have not had radiation then the tissue can be rearranged to close the defect and improve the overlying contour. If you have had radiation then I would recommend filling the space with your own tissue from another location. The reason is that radiation reduces blood flow, and increases the chance of complications if radiated tissue is cut.

Defects after lumpectomy are common and a good reason to consult a plastic surgeon. There are many options, but the solution will depend on the severity of the issue. Juvederm is not a good choice for breast reconstruction because it will not last. Local tissue rearrangement, fat grafting, or using a portion of muscle from another part of your body are all possible choices. This is where the clinical exam and the expertise of the plastic surgeon come into play. You can discuss your options and make a decision together that works best for you.

Lumpectomy often results in the indentation that you describe. The problem is that every lumpectomy leaves you with a unique situation! It is thus very difficult to answer your question here as there are so many individual questions that need to be asked? How big is the indentation? Where on the breast is it located? Did you have radiation to the breast? Was the implant placed before the lumpectomy or as part of a reconstruction? All of these questions influence how a repair can be done. I agree completely with Dr. Wallach that a breast reconstruction can be performed with either local or remote tissue depending on the situation. Fillers such as Juvederm are not going to fix this problem, and even if the indentation was small enough that Juvederm could fix it, it would only be a temporary cure. Alloderm can often be used to cover the edge of an implant that you can feel but not to fill a hole per se... Go see a plastic surgeon, get an individualized exam, and have an individualized plan developed to fix your unique situation! Good luck!

There are many different ways to reconstruct deformities of the breast after lumpectomy. Usually this requires one of several options: either using local tissue (i.e. the remaining breast itself) or recruiting tissue adjacent to the breast or even from a remote location( Latissimus muscle flap, ICAP flap, DIEP flap, TRAM) to improve the contour. It really depends upon how severe the defect is.