Video Series of Miami Plastic Surgery. Today, we'll be doing a breast reconstruction with fat grafting. Fat grafting is a new method of breast reconstruction that has really revolutionized and improved the way we do breast reconstruction. Our patient today has had a previous breast reconstruction with implants. However, fat grafting allows me to contour and shape the breast to each individual patient, as you'll see today. So please sit back and enjoy the video.

At the beginning by doing some liposuction, this is how we do the fat harvesting. You'll see that I'll put some local anesthetic and some epinephrine in here that will allow us to get out just fatty tissue and not any other fluid during this process. Once we've completed that, I'll show you how we actually process the fat to get the pure fat that we're going to use for our fat grafting. As you'll see during the procedure, there's actually a lot that goes into this from the time that we take the fat, to when we actually process it. We have six syringes of 60 ccs, so basically 360 ccs of fat have been collected in our canisters here.

You can see that this prefills them into each syringe and you can see, with even a little bit of time, the fat starts to separate out. So you get the extra fluid on the bottom and then our good fat above that. You can see the drastic color changes. I'm going to hand this to Adriana and she's going to put it in our centrifuge which will even help separate the fats and the fluid out even more, so that we can get some pure fat for our grafting. Up to the bottom, with this, the rest of the extra fluid will separate to the bottom. Any oil will be on the top and then the pure fat will be in the middle. We'll show you in a minute how we separate out that fluid out of the syringe, but this really helps you get the most possible pure fat to be re-injected. And this really gives people the ultimate result and most percentage of take.

So now we've completed the liposuction. You can kind of tell the endpoint of the liposuction, more of a feel than a true volume. At this point, you can see that there's mostly just skin and all the fat has been removed. And so at this point, I close the incisions where we did the liposuction. My great assistants are finishing up separating the fat and we'll proceed with the breast reconstruction and the fat grafting.

So now that we've processed our fat, you can see that it's in nice 10 cc syringes, the clean fat, and we have a bunch of it here. So we can slowly start putting that in place. The reason [inaudible 00:02:20] and then now it's just... This is the fun part of just slowly shaping the breast and really kind of making a big difference with some of these subtle changes for them. We'll just keep doing this until we get a nice feel for the smoothness, getting rid of any of these contour deficits or the little holes even, under the previous scar where typically people don't have as much soft tissue. We'll fill that in. It's also really great in terms of giving a better overall feel, so that people don't feel the implant. Also, a lot of breast reconstruction patients have had radiation or other stuff. This can actually soften up the skin, give them a little bit better overall appearance and texture to their skin. Patients that have rippling and so forth, it really makes a nice difference for them.

For her, like I talked about, we'll do a little more than what it looks like we even need. Because that'll help with the little bit of fat loss that we're going to have. There's always some limit to the amount of fat that you can put in one setting. You can fill the envelope, but you can't overdo it because the fat needs a good, healthy bed to survive.

People always ask about the overall texture once this is done once. You'll feel hard and swollen just like any other surgery. Once this is completed and you're a couple of months out, it feels like natural fat because that's what it is, and this is really one of the benefits of this over anything else out there. You can't make anything else be just like the fat in here. You're replacing what the breast tissue used to be. It just lets the fat be absorbed and integrated into what breast tissue and fatty tissue you already have that gives you the soft, natural contour and it increases the rate of fat survival.

So you can see already that it's lifted the scar up. It's given us some increased fullness on the superior pole here and it really just softens up and gives a nice contour here. Now we're going to come to the opposite side and do some filling out here laterally.

Reconstructed Breasts Don't Have to Feel Unnatural: Fat Grafting to the Breasts

Dr. Johnny Franco introduces a patient who wanted to improve the appearance of her breasts and make them feel more natural, so fat grafting was performed.