Can fat transfer techniques be successfully applied for breast reconstruction? Or are there better methods out there?
What is Lipofilling and How is It Used for Breast Reconstruction?
Doctor Answers 24
Fat transfer techniques can aid breast reconstruction
Fat transfer is a useful tool to optimize breast reconstruction outcomes. I recently fat grafted a patient's TRAM flap to improve volume, projection and shaping of the reconstructed breast. Insurance will pay for 'revision of breast reconstruction' and patients benefit from the liposuction required to obtain the fat for grafting. That's a double bonus for the patient !
Fat grafting has been shown to be a reasonable ancillary procedure to "touch-up" monor irregularities with breast reconstruction.
Fat transfer or lipofilling and breast reconstruction
Recently advances have been made in techniques to harvest and transfer living fat cells from patients and move them from one part of the body to another. Improving contour issues in breast reconstruction is one situation that fat transfer has an increasingly important role.
Most commonly, fat transfer is used to soften the interface between the edge of the implant and the surrounding tissues. Sometimes, the extent of the mastectomy is beyond where the implant will fill and a sharp stepoff is noted. Fat can be harvested from one part of the body (such as the abdomen, flanks, hips, or thighs) and prepared in such a way as to preserve the most living fat cells. These are then immediately injected into the tissues using special instrumentation that allows the fat to be deposited in small streams to increase the likelihood that the blood supply will grow into the fat tissue.
Sometimes, fat transfer can be used to increase the size of an autologous reconstruction (such as a TRAM flap or DIEP flap), or to correct localized contour deformities.
The use of fat transfer to correct post lumpectomy deformities, to enhance then size of a normal breast without using implants, or to creaste a breast mound without any additional need for tissue transfer or implants are exciting new frontiers that are currently being evaluated.
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Fat grafting in breast reconstruction
Fat grafting is often used in breast reconstruction for two main reasons -
- To correct the "shelf" that occurs between the chest wall and the upper pole of the implant
- To correct contour irregularities around the implant (palpable ripples, thin areas of skin, etc.)
The fat is removed from another area of your body (abdomen, thighs, hips) and is processed to isolate the fat cells. These fat cells are then injected into the area you wish to fill. Depending on technique, a percentage (the higher the better) of this transplanted fat will "take" or live and thus correct the deformity. Sometimes, more than one surgery is required to correct an area.
Some insurance companies deem this procedure as "investigational" and will not pay for it. It is important to discuss this with your surgeon prior to undergoing fat transfer. Other options include using dermal fat grafts (leaving fat attached to skin and transplanting as a single unit) and dermal matrices such as Alloderm.
Lipofilling or fat transfer can be very useful in breast reconstruction.
Fat transfer is not the primary technique in breast recostruction, but we often use it to add finesse and a more natural look AROUND the main reconstruction.
The main breast reconstruction is done with an implant or a flap. But there can be hollows or defects from the mastectomy around the implant or the flap. This is where filling in with fat injections can turn a good result into a great result.
Lipofilling allows fine tuning of reconstructed breast contour
Fat transfer for breast reconstruction
Hope this helps
The use fat grafting in breast reconstruction
I have also used fat grafting to correct contour deformity after lumpectomy and radiation. However, the use of fat grafting as a primary breast reconstruction technique after mastectomy has been reported but if limited successful result.
I recommend to all patients with breast cancer to work closely with all their doctors including oncologist, oncologic breast surgeon, and board certified plastic surgeon to plan out their breast reconstruction.