Fat transfer to extreme dense breasts?

Question

Hi, I would like to do a fat transfer to the breasts. The mammogram shows that I have extreme dense breasts (ACR Category D). I do have enough fat (to be transferred).My concern is that being the breasts so dense the cannulas would puncture/ go inside the milk ducts and gland and damage them. Is this true? Is it safe to inject fat in the mammary glands? Thank you for your replies

J. Timothy Katzen, MD, FACS · Answer

Dear ibac,

Fat transfer to breasts can be performed on patients with dense breast tissue, however, it requires particular care and expertise. In cases of extremely dense breasts, there might be a higher risk of complications such as fat necrosis, oil cysts, or calcifications, and these can potentially make future mammograms more challenging to interpret.

Fat transfer is usually done with a cannula, which is designed to reduce damage to the surrounding tissues. Nonetheless, some damage to the milk ducts and glandular tissue is inevitable in the process. However, this is typically minimal and doesn't generally lead to significant problems. The safety of injecting fat into mammary glands is still a topic of debate among experts.

It's crucial that you have a detailed discussion with your plastic surgeon about your specific case. Make sure they have experience dealing with patients who have dense breast tissue. In addition, you should also discuss your plans with your radiologist or breast surgeon, who can advise you about the implications for future breast cancer screening.

Sincerely, 
Dr. Katzen.

Alan Gonzalez, MD, FACS · Answer

Hello @ibac, thank you for your question. Fat transfer the breasts is a two-in-one procedure that combines liposuction and fat grafting. The procedure adds volume and contour to the breasts by transferring fat cells from other areas of your body.  Fat grafting can be done safely with ultrasound-guided cannulas in order to provide consistent results while avoiding any potential damage to underlying structures. The importance thing is that you have your procedure done with an experienced specialist in this procedure.   For more information and recommendations consult one or more board-certified plastic surgeons. . Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Connie Hiers, MD, FACS · Answer

The fat should not damage milk ducts, but it will be harder to transfer due to dense breasts.  Fat transfer has the least risks of damage to milk ducts.

Douglas Taranow, DO, FACOS · Answer

It is almost impossible for the thin cannulas to penetrate dense breast tissue during a fat transfer.  You may place the fat around the dense tissue and under the breasts (just above the pectoralis muscle).  Usually implants are a better option for augmentation.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

Each plastic surgeon will have their own technique for where they graft fatty. Fat grafting typically doesn’t work so well through with dens breast parenchyma, so most of the fan is typically grafted in the subcutaneous, fat layer, and sometimes under the breast.
The procedure gives subtle results and isn’t for everyone. It’s also the more difficult procedure to get right than most people think.
Even when done correctly, it increases breast size by 1/2 cup, but does not change breast shape in any meaningful way.
Having fibrocystic breast tissue makes the procedure technically more difficult.
Best,
Mats Hagstrom, MD

Fat transfer to extreme dense breasts?

Answers (5)

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