What causes the fat to turn into cysts?

Question

I had a fat transfer surgery to the breasts. I used the brava unit for a month before, as advised. All of the fat turned into cysts. I had already had surgeries on my breasts. I had implants, and then removal. I wanted to refill some of the areas where I lost tissue. I will have the cysts removed next week. I would like my doctor to try again, but I don't know if it is worth it.

Michael M. Omidi, MD, FACS · Answer

Any time there is a foreign body or a fluid collection, your tissues will try to separate it form itself.  It forms a lining that becomes the wall of the cyst.  If the fat does not develop blood supply or if the contents are related after cell death, then a cyst will be formed.  Best of luck to you.  Dr. Michael Omidi

Steven Wallach, MD · Answer

If the fat dies, then it can form small cysts of oil and other cell particles.   This is one of the complications of fat grafting.

Victor Ferrari, MD, FACS · Answer

If the transferred fat dies, it can either form a hard lump or into an oily substance.  The oil is then surrounded by a thin layer of scar tissue and therefore forms a cyst.  Also, when fat is harvested, some of the fat cells rupture and the fatty oil is released from the cells.  If the surgeon does not remove that layer of oil prior to transfer, then you will end up with oil cysts.  You may want to consider seeking another PS if you want further fat grafting (just a thought).

R. Stephen Mulholland, MD (retired) · Answer

Dear Time3,

Thank you for your clinical post.  Following the explantation fat grafting the
breast can be an excellent procedure. 
Primary augmentation with fat grafting to the breast can also provide a
modest increase in volume and proportion without artificial breast implants.  While fat grafting to the breast can be very
predictable and safe there are some complications.  If the fat does not pick up a blood supply it
will not survive and if it does not survive it can form solid fibrotic lumps or
there can be some of the oil contained within the fat.  Some of the oil contained within the fat can
be encased in a thin wall forming a cyst. 
Cystic degeneration or fibroplastic lumps following fat grafting are one
of the complications.  Fortunately, cysts
and fibrotic lumps can be easily discerned on MRI or mammogram and
differentiated between breast cancers, breast cancers by well-trained Canadian
radiologists. Cystic degeneration that is symptomatic are concerning and
would be addressed with needle aspiration or lumpectomy.

Should one entertain a second fat grafting procedure to the
breast if the initial one has been unsuccessful?  This is a good question, but in general a
well-performed fat grafting surgery is usually universally successful in
achieving some degree of fat survival. 
The range of fat survival can be between 30% and 70% and generally a
second session is usually preplanned and recommended one year after the first
session.  At the time of the second
session there is more viable fat and hence more blood supply to support
additional volume.

I’ve been performing fat grafting together with lipo
contouring for over 20 years and fat grafting to the buttock, breast and face
is very common.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

What causes the fat to turn into cysts?

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