1 breast looks "pockmarked" w/tissue below after En Bloc capsulectomy & fat transfer. Can a 2nd transfer fix it? (Photo)

Question

I had an En Bloc capsulectomy w/simultaneous fat transfer. I had severe pec retraction & very severe indentation on the R (1" deep) and moderate retraction & chest wall indention on the L. He injected 420 mL of fat to the R, & 325 to the L. My left breast is fine, but on my R: 1. There's a thin area of tissue below my R breast, 2. When I lift my arms, the R breast has small "pockmarks." 3. The upper part of my R breast looks nearly flat. Causes & ways to fix?

Ajaya Kashyap, MD · Answer

Thank you for your query. A second session of fat injections should help. I usually do a radio frequency skin tightening as well, in this situation as well. Please discuss your concerns with your Plastic surgeon who can examine you and help you with all your concerns. All the best!

Daniel Barrett, MD · Answer

Dear SIEF37,
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

Arif Eroglu, MD · Answer

Hello,The fat injection done in the breast is not the same as in the hips. Usually, significant volume increase cannot be achieved in just one session. For a breast that requires serious shaping and volume change, fat injections should be done 3 times at 6-month intervals. You have only had one fat injection so far. If there is enough fat tissue, I would recommend having another fat injection.

Gerald Minniti, MD, FACS · Answer

First, I'd like to say that you did not need a total intact capsulectomy, which is what you actually got, not a true en bloc capsulectomy. The reason I say that is because published data show that women with symptoms they attributed to their breast implants had exactly the same outcome with no capsulectomy at all. I'll say it again, removing the implant capsule has no effect on symptom reduction. Having said that, your dents and irregularities are either from the fat grafting or from irregularities in your native breast tissue cause by the capsulectomy. High resolution ultrasound can confirm fat necrosis and the possibility of oil cysts from fat grafting. The difference between your breasts has to do with the breast themselves: the right breast is ptotic and displaces more with arm position. More fat grafting of the right breast without a unilateral breast lift will not improve that issue.

Gary M. Horndeski, MD · Answer

Yes, you can have a 2nd fat transfer.  I would suggest you wait 6 months to 1 year after the 1st fat transfer.  You would also benefit from a donut mastopexy to take in some of the loose skin.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

First, "enbloc excision" is used in cancer surgery only to remove surrounding breast tissue that is at risk. It does not mean removing the capsule. Second, another fat transfer can be done to help fill in empty and thin areas.

Darryl J. Blinski, MD · Answer

Based on your photos, your result is very acceptable though there is a cemetery most likely that’s due to some asymmetry before the surgery and at this point, I always tell any explant patient with fat grafting. They may need 2 to 3 surgery in separate stages. You need a second stage most likely a lift on the lower side with some additional fat grafting. Best virtual consult with expect fees to range from $10,000-$20,000. Again best to virtual consult with.

1 breast looks "pockmarked" w/tissue below after En Bloc capsulectomy & fat transfer. Can a 2nd transfer fix it? (Photo)

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