Explant, breast fat transfer, lipo revision?

Question

I had lipo on thighs and arms and implants two years ago. I want to explant. How many months should I wait until I do fat transfer after the explant? One surgeon suggests 1 month, another says we can do a small amount immediately after the surgery (150 cc) and the rest 3 months and 6 months later using my frozen fat. Also, can I use fat harvested from areas I already did lipo on?

Gary M. Horndeski, MD · Answer

I frequently do explants. I have done fat transfers simultaneously but usually it is not as effective. I recommend you waiting approximately 6 months then a large amount of fat can be transferred. We do not use frozen fat and you can harvest from other previous sites.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Alan Gonzalez, MD, FACS · Answer

Hello @_Sprinkles_, thank you for your question. Really, the time for recuperation needed for a fat transfer after an explant depends un the surgical technique of the specialist performing surgery. It is always necessary to completely remove the capsule and reconstruct the tissue. As I see it, fat transfer or fat seeding should take place in a later process with a time horizon of 2 to 3 months. This is in order to ensure that the fat is fixed to the tissues and reduce the chances of infection or fat death. The best course of action is to consult one or several board certified plastic surgeons for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS .

Ronald J. Edelson, MD · Answer

There are no hard and fast rules when it comes to the timing of fat transfer. Nobody knows the ideal timing or if it makes any difference at all with regard to fat retention and as far as I know it has not been studied. It’s really the hit or miss approach and hope for the best

Daniel Barrett, MD · Answer

Dear _Sprinkles_,
you should fully recover from one surgery before you get another elective procedure. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

You could have some fat inserted if implants are removed and no lift at the same time. If fat is still present in the areas treated, then more fat could be removed.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question. We have had the best graft survival then breast fat injection is done at the time of the explant.  The capsule of the implant is very vascular which is a good area for injection. It is best of course to have a consultation either in person or virtually to  discuss options.

Mats Hagstrom, MD (license on probation) · Answer

What’s more important than anything else as you find the surgeon who is best at doing liposuction and fat transfer based on their before and after portfolios. 
I suggest all patients have multiple in person consultations during which they should ask each provider to open up their entire before and after picture portfolio and show you as many pictures as you need to to get absolute confirmation of what the average results look like in the hands of each provider. delivering consistent liposuction and fat transfer results is more difficult than most people believe. you need to make absolutely sure that fat transfer results pictures were taken at least three months from the date of the surgery. Anything earlier than that does not represent final outcomes.
Fat transfer done at the same time as explantation offers a unique approach to being able to graft from inside the breast towards the skin which is lost once things are healed up. it’s always better to graft conservatively and do it multiple times then over grafting. that said my typical breast fat transfer case is probably closer to 500 cc per side on average.
I see no reason why you couldn’t graft in conjunction with explantation then come back for a second session if needed.
You should recognize that fat transfer does not change the shape of your breast at all it only increases size. fat transfer will never give the shape or character that implants can.
The single biggest drawback to doing fat transfer in conjunction with explantation is that the patient never gets a chance to have before and after pictures of the impact of that fat transfer.
Your breast will not look like pre-augmentation after explantation and it’s always good to have a baseline to see what the fat transfer was able to accomplish.
Conceivably the surgeon could sit you up in the operating room after removal of implants and take pictures during surgery as a baseline of what your breast look like post explantation prior to grafting fat.
Secondary liposuction is generally less desirable in regards to harvesting fat and quality results then doing primary liposuction.
Without including pictures we can’t make any assessment in regards to what areas are appropriate to treat or any other assessments than general statements.
When reviewing before and after pictures you should ask providers to go over liposuction results and look carefully at all areas treated to make sure there are no contour irregularities whatsoever in any area treated with Liposuction. ask the providers to review the pictures with you and go over what areas were treated with Liposuction and what areas were not looking carefully at transition zones between treated and untreated areas.
An experience provider should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures like liposuction and fat transfer.
Ask providers to show you as many pictures as possible a patient with similar body characteristics to your own. You should also ask him to show you examples of excellent outcomes, average outcomes and less than outcomes. We all have a variety of outcomes and it’s fair game for patients to ask to see different types of outcomes.
Being shown a handful of selected pictures which most likely represent the best results of the providers career is totally insufficient to get a clear understanding of an average results look like in the hands of each provider.
Considering the learning curve for mastering both Liposuction and fat transfer it is by far the most important decision to find the most experienced and talented provider.
You should ask each surgeon how many times they’ve done this exact procedure before and what their hesitations are of doing fat grafting in conjunction with explantation.
If they’ve never done it before then maybe you haven’t found the right provider yet.
Continue having consultations until you feel quite comfortable you found the most talented and experienced provider for this procedure.
And there are also other variables to consider. If you have any type of capsular contracture then is the capsule going to be removed with the implant?
Are they placing drains as part of the explantation?
What is the purpose of explantation?
Avoid virtual consultations whenever possible and continue having thorough in person consultations at which time you should thoroughly vet providers to be able to differentiate who has the most talent and experience.
Best,
Mats Hagstrom MD

Explant, breast fat transfer, lipo revision?

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