Breast reconstruction after mastectomy is a surgical procedure that replaces the volume and contour of tissue that was removed during a mastectomy. This procedure has been used for many years and has undergone constant improvements throughout its history. The process involves taking fat from another part of your body and transferring it to your chest. There are several ways to do this: autologous transfer, allogeneic transfer, or synthetic grafts.
In this blog post, we’ll discuss the benefits and drawbacks of each method as well as how you can get started on your recovery after breast reconstruction surgery.
Breast Reconstruction After Mastectomy Fat Transfer
What Is Fat Transfer?
Fat transfer is a type of cosmetic surgery that involves transferring fat from one part of the body to another. For example, if a woman has lost weight from her upper arms or thighs and wishes to regain fullness in those areas, she may choose to have fat cells removed from those places and injected into her breasts to help restore volume. This process is always performed under local anesthesia and does not require incisions in order for the cells to be transferred successfully.
Is It Safe?
When carried out by a skilled plastic surgeon who performs hundreds of these procedures each year, fat transfer is safe. In fact, fat transfer has been used widely since 1992 with very few complications reported over this time period.
Fat Grafting After Diep Flap Reconstruction
Women with breast cancer may undergo surgery as part of their treatment. Breast reconstruction surgery after a mastectomy or lumpectomy can restore a breast’s shape and appearance. In addition to more traditional reconstructive breast surgeries offered by UPMC’s Department of Plastic and Reconstructive Surgery, we offer structural fat grafting for breast reconstruction.
In structural fat grafting, a doctor harvests fat from one or more areas of your body and grafts it to another area. In this scenario, the doctor would move the fat to your breasts to create a smooth, more symmetrical, look. Because the procedure uses your own fat, it’s a more natural process than implants.
Is Fat Grafting Right for Me?
Structural fat grafting for breast reconstruction can improve the look left behind by previous procedures, including:
- Lumpectomy
- Mastectomy
- Radiation therapy
- TRAM flaps or similar surgeries
If you are healthy enough to undergo a surgical operation, you are most likely a candidate for this procedure. Structural fat grafting can create more symmetrical breasts and smooth over any scarring, dents, or other issues.
Before the Procedure
Before getting structural fat grafting for breast reconstruction, you will meet with the surgical team to learn about the procedure. A member of the team will examine you and take photos of your chest. Using the photos taken, the surgeon will work with you to create a tailored plan for your procedure. Part of this plan includes a color-coded blueprint of your procedure showing:
- Where fat will be removed
- Where the fat will be placed to create a smooth breast contour
- Where the surgical team will make the tiny incisions to place the fat
Breast Reconstruction Fat Grafting Details
Your procedure will begin with the surgical team marking your body based on the agreed-upon blueprint. You will actively participate in this process.
Once all parties agree to the plan, the doctor will harvest fat from your body, from one or more areas including:
- Abdomen
- Arms
- Flank area
- Love handles
- Inner thighs
- Outer thighs
Your doctor will make sure the removal of fat leaves an enhanced area behind.
After harvesting the fat, the surgical team will put it through a centrifuge to refine and concentrate it. The process removes unwanted components like blood, oil, and water.
The doctor will then add the fat, little by little, to your breasts, sculpting to make sure you get the desired result.
Depending on the scope of the procedure, it can last anywhere from under an hour to five hours.
Fat Grafting Breast Reconstruction with Implant Recovery
Your recovery will likely depend on how much fat the surgical team harvests and how many areas they harvest it from. In general, the more fat and more areas used, the more uncomfortable your recovery will be.
Your breasts will be swollen and bruised, but you should experience little pain in that area. Most swelling in the region should subside within three weeks.
The donor sites will be bruised, swollen and sore, and swelling there can last longer – up to six months.
For the first three weeks, we advise not putting too much pressure on your breasts. That means avoiding sleeping on your stomach or doing rigorous upper-body exercises.
We advise taking about 10 days off of work after a bigger surgery, so you can comfortably ease back into your routine. You can begin light exercise 10 days to two weeks post-procedure.
Anticipated Results
The end results of your surgery may not be seen until months after the procedure, and the positive effects can continue for years after.
While fat can be easily damaged, structural fat grafting places it close to a blood supply to give it the best chance for survival. The surgery can fix problems left behind by previous procedures to give your breasts a better look.
Structural fat grafting can:
- Restore breast volume
- Soften the contours and hide the edges of breast implants
- Shape breasts more naturally
- Create cleavage
- Improve the look of scars
- Heal radiation-damaged skin
Risks
Complications are rare with structural fat grafting, but those that can occur include:
- Bleeding
- Infection
- Scarring
- Irregularities
- Placing too much or too little fat
Scarring and calcification can occur with structural fat grafting, just as it can with other breast procedures.
Benefits of Breast Reconstruction Using Fat Grafting
Breast reconstruction using structural fat grafting can fix scarring and other skin damage from various procedures. It can create a more symmetrical look overall.
Other benefits of using structural fat grafting include:
- A natural tissue: The fat is your own and cannot be rejected as a foreign tissue. Your own fat will feel like breast tissue.
- Better shaping: The doctor places the fat precisely with tiny amounts at a time, making it easier to create a symmetrical look.
- Reduced pain: Skin can become softer and more flexible after fat placement, leading to less pain and stiffness.
- Long-lasting results: The softening benefits of stem cells can last for months or years after the procedure.
Fat Grafting Fat grafting, also called autologous fat transfer, is emerging as a new breast reconstruction technique. Fat grafting, also called autologous fat transfer, is emerging as a new breast reconstruction technique. In fat grafting, fat tissue is removed from other parts of your body — usually your thighs, belly, and buttocks — by liposuction. The tissue is then processed into liquid and injected into the breast area to recreate the breast. Another form of fat grafting, called lipofilling, has been used for a number of years to fix minor differences in the shape, balance, or position of the reconstructed breast compared to the other breast.
Since that has worked well, doctors thought they might be able to rebuild a whole breast using fat. It can be tempting to think about fat grafting as a “safer” procedure, since it doesn’t involve major surgery. However, we’re not yet sure how successful it will be over the long-term. Because fat grafting is so new, no large clinical studies have been done on the procedure. The studies that have been done involve fewer than 100 women and the average follow-up time is less than 4 years. It’s also important to know that in many cases, the fat injected into the breast area may be reabsorbed by the body over time and the breast may lose some volume. This is why some plastic surgeons initially may add more fat than you think you need. In addition, if fat grafting doesn’t work and you decide you want a flap reconstruction, you may have already used up an important source of tissue such as the belly area.
These are all things to keep in mind. In one type of fat grafting procedure, an external tissue expander called a Brava device is worn for several weeks before and after the fat grafting. The Brava device is like a bra with plastic cones for cups. The cones put suction on the breast area to expand the tissue and create a matrix for the fat to live in. Wearing the Brava device seems to be important for the reconstructed breast to maintain its volume. In one study, women who didn’t wear the Brava device as directed had their breast volume decrease nearly twice as much as women who wore the Brava device. Depending on the size you would like your reconstructed breast to be, you may have to have multiple fat grafting procedures that are done over a period of months, usually under general anesthesia.
The benefits and risks of fat grafting The advantages of fat grafting are: It uses your own tissue instead of an implant. Fat is removed from an area where you don’t want it. Many women report that their fat-graft-reconstructed breast has some sensation and feels soft, much like the other unreconstructed breast. The disadvantages of fat grafting are: No large clinical studies with long-term follow-up have been done on fat grafting; while small studies report good results, we don’t know if this technique will work for all women and we also don’t know how long the results will last. Depending on which surgeon you choose to do the procedure, you may be required to wear the Brava device or another type of external tissue expander for 4 or more weeks before the fat injections and for several weeks after. It may require 4 to 6 individual sessions to get the best potential results.
Over time, the body may resorb the injected fat, causing you to lose some or all of the breast volume. Because some fat cells can stimulate cell growth, some doctors are concerned that fat injected into the breast area may cause dormant breast cancer cells to grow. Research needs to be done to find out if this is true. Some of the fat injected into the breast area may die, which is called “necrosis.” Symptoms of necrosis may include pain and bleeding, the skin turning dark blue or black, numbness, fever, and sores that ooze a bad-smelling discharge or pus. You may exhaust a key tissue source for a future flap reconstruction if fat grafting doesn’t work.