Breast reconstruction question ? fat transfer to build up my breasts

Hi, thanks for your question. A nipple sparing mastectomy does result in a very small amount of breast tissue being left behind the nipple - it is typically quoted that approximately 95% of breast tissue is removed with a mastectomy. Transferred fat can survive in your breast reconstruction provided it is placed into the correct tissue plane, which in your case would be into the mastectomy skin flaps overlying the implant (or the muscle if your implant is under the muscle). Fat transfer is useful to address implant visibility (rippling) and palpability, and to improve the overall shape and skin quality in reconstructive breast surgery.

Excellent question. Fat can be grafted in any portion of the breast area, even in patients who have had a mastectomy. It is important to note that when it comes to fat grafting, the amount of breast tissue and subcutaneous tissue present at baseline will dictate how much fat can be transferred with success. For example, patients with more tissue have more areas that the transferred fat can incorporate into and survive due to the blood supply to those areas. Conversely, in patients with very little tissue (or patients with a history of mastectomy), there is less tissue to inject that transferred fat into. This means that smaller volumes can be transferred at one time, and, often times multiple surgeries are needed to build up to the desired volume.
If you already have an implant in place, fat grafting can be a great adjunct to add a little more volume and to blend the implant into the chest to make a more natural result. Often times, the step-off from the implant in the upper pole is blended with fat to make a smoother transition. This is a popular place to transfer fat, but it is not the only place where fat can be transferred. Every patient has a different chest wall anatomy and shape, so the placement of fat can be individualized to each patient. The decision ultimately based on a conversation between you and your plastic surgeon to see what is best for you given your anatomy/frame and your ultimate goals.

Dear booboo32,
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