How long after lumpectomy and radiation will I need to wait before I can have fat transfer to the defect?

Question

I have a small 8 mm invasive ductal carsonoma ER+ PR+ HER2-. It will be removed soon. I have very small breasts and believe surgery will result in a very noticeable defect even though the tumor is small. I'd like to have fat transfer as soon as it is safe to do so. Is fat transfer safe after cancer? Will fat transfer help the radiated breast look and feel normal?

Michael Orseck, MD · Answer

Fat grafting, or any surgery after radiation is best delayed for at least 3-6 months and sometimes up to 12 months.If your breasts are truly very small, sometimes a lumpectomy and radiation isn't the treatment that will afford the least amount of surgery and disfigurement.Often, a nipple sparing mastectomy and immediate reconstruction may be a better option.Make sure you see a plastic surgeron before your lumpectomy.Good luck!

Ritu Chopra, MD · Answer

The timing of fat transfer is variable but I would wait at least 6 months. Fat transfer is a good option and some studies have shown that it actually helps the radiated skin. I do fat transfer to the majority of my reconstructed patients and it works great! I hope this helps!Ritu Chopra MD

Tassos Dionisopoulos, MD · Answer

the radiation that you will receive will permanently alter what remains of your breast. the defect after lumpectomy and radiation can often be greater than that of the lumpectomy alone. trying to "correct" this can be frustrating yielding poor results, even with fat grafting. given that your breast is small, you should consider a nipple and skin sparing mastectomy with immediate reconstruction. this way , if the results of your sentinel lymph node biopsy are favorable, you can avoid radiotherapy. this can be done in one or two stages, usually placing the device beneath your chest muscle. a new approach to immediate breast reconstruction involves placement of the implant directly into the space where the breast was removed, ie: prepectoral (in front of the muscle). an 'acellular dermal matrix" (ADM) is used as well to minimize capsular contracture.

Hisham Seify, MD, PhD, FACS · Answer

You will need to wait about 3-6
months after radiation to have fat transfer to the defect.

Brian Arslanian, MD · Answer

Radiation therapy can cause problems in the breast in terms of the blood supply and contraction of tissues.  The longer you can wait the better, but obviously you don't want to walk around with a defect forever.  I think 6 months is probably safe for fat transfer.  And yes, fat actually can improve the quality of the radiated skin.  The thing to consider is radiation therapy can constrict the breast and lift it and make it smaller and tighter.  Even by injecting fat you may not be able to stretch that skin back out to its pre-radiation state.  If you had large breasts I would recommend an oncoplastic breast reduction.  With small breasts you might want to consider a mastectomy or even a bilateral mastectomy.  This is obviously something that you need to discuss with your oncologic decision.  If a large lumpectomy is done on a small breast, it is going to leave it very asymmetric, and fat alone may not treat it.  One option would be a mastectomy and reconstruction with tissue from your belly to give you a very natural look that will match the other side.  Depending on your family history and discussions with your surgeon, performing a bilateral mastectomy and then reconstruction with your own tissue or even implants, will give you a more symmetric look.  Its hard to get a radiated reconstructed breast to match the other side.   Good luck in your decisions, and I hope your recovery goes well.

Mark Shashikant, MD · Answer

Fat transfer is considered safe after cancer and can help a radiated breast look and feel normal.  While long-term human studies are needed, there is evidence that fat grafting not only helps with the immediate inflammation from radiation but may slow or halt the progression to chronic inflammation.Currently almost all of my breast cancer patients receive fat grafting.  I wait at least four weeks.Fat grafting is a realtively new and excting technique with a lot of promise for patients.  I encourage you to consult with a board certified Plastic Surgeon to discuss your options.

How long after lumpectomy and radiation will I need to wait before I can have fat transfer to the defect?

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