Breast reconstruction question ? fat transfer to build up my breasts

Question

I had a nipple sparing mastectomy in 2017 which was direct to implant ... I would like to use fat transfer to build up my breasts . As I've had nipple sparing does that mean I have a small amount of residual breast tissue under the nipple? As I have no breast tissue would transferred fat survive in my breast? I assume it requires a blood supply which I assume can be obtained via the skin ? I've heard conflicting opinions but assume it's a viable technique as it's now widely used in recon.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

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.

Brian Bassiri-Tehrani, MD · Answer

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.

Daniel Barrett, MD · Answer

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

Zoran Potparic, MD · Answer

Fat grafting of breasts after reconstruction was one of the first areas were fat grafts were used. Although there is significant experience accumulated in that field, it is still very challenging procedure, which usually requires 2-3 stages of fat grafting to achieve desired volume and shape. It would be in your best interest to have a consultation with a board certified plastic surgeon who has significant experience in this procedure. Hope this helps. Good luck.

Connie Hiers, MD, FACS · Answer

You need to be examined to see what can be done with fat. Yes, fat can still be added even if there is little breast tissue.

Hilton Becker, MD · Answer

Fat grafting can be done after skin sparing mastectomy
It requires fat be reduced to micro particles ,which is what I do 
I also combine the fat grafts with PRPorPRF
Depending on the thickness of the flaps, it may take several procedures

Mats Hagstrom, MD (license on probation) · Answer

Fat transfer is not an appropriate reconstructive option after mastectomy. If you want to use your own tissue for reconstructive purposes, then you must likely need to consider the standard autologous tissu Rc Construction options, which generally include a latissimus flap, TRAM weather, free flap, or pedicled flap as well as DIEP flaps. Fat grafting requires an abundance of host tissue, which you likely do not have since you had a mastectomy. Some reconstructive patients may benefit from fat transfer to build up thin layers of fat to help cover the implant, and it can be a useful tool, but will not give any significant volume. Fat transfer in situation, like yours often to give very small amounts of fat that survive and getting any real progress often requires multiple surgeries.
Talk to you reconstructive surgeon about reconstructive options.
Sometimes Revision of a reconstructed Breast is appropriate and sometimes it’s better to not mess with some thing that is already working 
Best,
Mats Hagstrom, MD

Derek Fletcher, MD - Account Suspended · Answer

Fat grafting after mastectomy and implant-based breast reconstruction is very common.  In this context, the fat grafts add additional thickness to the mastectomy flaps, which can eliminate or reduce visible implant rippling and improve the contour of the breast, especially in transitional areas like the chest and under arm.  In order to survive, fat grafts need to be gently harvested, carefully processed, and injected into the recipient site in small droplets to maximize contact with the soft tissues they are injected into so that they can receive nutrition by diffusion.  Over time, capillaries will send new blood supply to the fat grafts, ensuring longterm survival.

Breast reconstruction question ? fat transfer to build up my breasts

Answers (8)

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