Fat Grafting

Plastic surgeons can reconstruct a breast with a fairly new technique called fat grafting (or fat injections). A surgeon uses liposuction to take fat tissue from your thighs, abdomen, or buttocks and transfers the fat to your breast to reconstruct it. This type of fat grafting breast reconstruction is also called autologous fat transfer and is usually performed under general anesthesia.

Surgeons can also use fat injections to make minor aesthetic changes to a breast’s shape, balance, or position after breast reconstruction surgery. This type of fat grafting is sometimes called lipofilling and has been around for much longer. Depending on how extensive the procedure is, it can be performed under local or general anesthesia.

Some plastic surgeons might recommend that you wear an external tissue expander, called a Brava device, for several weeks before and after a fat grafting procedure. The Brava device is like a bra with plastic cones for cups. The cones work like suction cups, applying gentle pressure to expand breast tissue and make more room for the transferred fat.

Your plastic surgeon might not suggest you use a Brava device as part of fat grafting or may simply not offer it. If you’re interested in using a Brava device as part of a fat transfer to the breast, talk to your plastic surgeon, breast surgeon, and the rest of your cancer care team to ensure everyone’s on the same page about what makes the most sense for you. 

Some of the advantages of fat grafting include the following:

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  Your body can’t reject the transferred fat since it’s your own tissue.

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  You can avoid breast implant reconstruction if you prefer not to use an implant.

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  A breast reconstructed with fat grafting feels similar to breast tissue.

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  Recovery is typically straightforward and quick.

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  According to some plastic surgeons, 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 include the following:

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  As with any surgery, risks can include bleeding and infection.

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  Some of the injected fat tissue may break down, die, and turn into scar tissue — called fat necrosis. People who are injected with a greater volume of fat in a single session have a slightly higher risk of developing fat necrosis than people who have smaller amounts of fat injected. ¹

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  When fat necrosis develops, it can result in a firm nodule or a lump in the breast that might be mistaken for breast cancer recurrence.

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  You might need multiple fat grafting procedures throughout a period of a few months, usually under general anesthesia, depending on the size you would like your reconstructed breast to be.

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  After some time, your body reabsorbs the injected fat and your breast may lose some volume. Some plastic surgeons add more fat than you think you need during the procedure to try to compensate for future volume loss. But since there’s only so much fat your surgeon can inject in one session, you may need more than one session to get the best results.

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  If the fat grafting procedure doesn’t work, you cannot use tissue from that same area in your body for flap reconstruction surgery in the future.

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  If you have to wear a Brava device, it extends the whole procedure by several weeks before and after fat grafting.

A recent study found that fat grafting does not increase the likelihood of breast cancer recurrence. Larger studies with longer follow-ups are still needed to see the long-term benefits of fat grafting as a whole breast reconstruction option (like flap reconstruction and breast implant reconstruction) rather than combined with other reconstruction techniques. ²

If you’re considering fat grafting, talk with your plastic surgeon about whether your results are likely to match your expectations.

 

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