Fat Grafting for Breast Reconstruction

After you’ve had a mastectomy or lumpectomy, with or without breast reconstruction, you might decide that you want to make some small changes to the shape or feel of your breasts or chest. Maybe there’s an uneven area, a dent, or a breast that seems less symmetrical. Fat grafting (also called fat transfer, fat injections, or lipofilling) is a common follow-up procedure for making these tweaks. It can add volume and softness, improve symmetry, and smooth out divots.

During fat grafting, a plastic surgeon uses liposuction to remove fat from another part of your body, such as the thighs, belly, hips, or buttocks. That fat tissue is then processed into a liquid paste and injected into the breast area. Typically, about half of the fat that’s injected survives long term.

Fat grafting is considered safe for most people who’ve had breast cancer. Research suggests that it doesn’t increase the risk of breast cancer recurrence. And most people are candidates for fat grafting, as long as they have enough fat elsewhere on their body to remove for the procedure.

However, smoking and certain health conditions such as high blood pressure or diabetes may raise the risk for complications from the procedure. Your plastic surgeon can help you understand if you’re a good candidate and what to expect if you get fat grafting.

Many people like that fat grafting involves using your own tissue and that it can produce a natural look and feel. But results vary. Some people may keep more of the transferred fat than others, and some have a more painful recovery. Also, you may need more than one procedure to get the results you want.

Fat grafting may be done after mastectomy, lumpectomy, any type of breast reconstruction, or as part of corrective reconstruction. Depending on your individual situation, fat grafting may be used to add volume to the breast, adjust its shape, smooth out divots, improve scars, and thicken the soft tissue layer over a breast implant or an autologous flap (this can help provide a more natural appearance, mask implant rippling, and can also prevent or correct certain complications).

Fat grafting generally isn’t used on its own to fully reconstruct the breasts after a mastectomy. However, some plastic surgeons offer fat grafting as a complete form of breast reconstruction. Researchers in the U.S. and other countries are studying several techniques for using fat grafting in this way. Because of this, some health insurance plans consider the procedure to still be experimental and may not cover it.

Fat grafting is most often done a few months after the main breast reconstruction surgery or aesthetic flat closure surgery. Sometimes it may be done during a surgery when tissue expanders are exchanged for an implant or autologous flap, or during a surgery to correct a complication, like an implant displacement.

When fat grafting is done on its own it’s typically an outpatient procedure, meaning you can go home the same day.

Planning the procedure

Before you get fat grafting, you’ll meet with your plastic surgeon to decide which part of your body the fat will be taken from. This is called the donor site. In some cases, fat may need to be taken from more than one donor site. The thighs, belly, hips, and buttocks are common donor sites. The donor site may change after fat grafting. For example, your belly may appear flatter if fat is removed from that area.

You’ll also discuss with your plastic surgeon how many sessions of fat grafting will be needed to get the best results. This number may change depending on your results from the first session or two. Procedures are spaced at least three months apart. 

During the procedure

A fat grafting procedure takes about one to three hours.

Fat grafting is usually done under general anesthesia, but in some cases local anesthesia with sedation may be used instead.

The surgeon injects a special solution into the donor site to reduce bleeding and bruising. It also may help numb the area. Then they make a small incision, use a syringe to extract fat, and close the incision with stitches.

Sometimes, they may remove fat from more than one donor site.

The fat is then processed to remove impurities and prepare it for transfer.

The surgeon makes small incisions in the breast or chest, injects the fat using small syringes, and closes the incisions with stitches.

Recovery

You will have bandages that you’ll need to keep over the incisions for a couple of days. You’ll also need to wear a medical compression garment or leggings over the donor site for at least two weeks. This helps to reduce swelling and bruising. You should also avoid strenuous activities (such as running) for two weeks. Your surgeon may prescribe antibiotics to prevent infection.

You may have pain, swelling, bruising, and scabbing during the first two weeks after fat grafting (especially in the area where the fat was removed). Your healthcare team may recommend over-the-counter or prescription pain medications.

Seeing the results

It takes several months to see the results from fat grafting. Some of the injected fat will not survive and the rest needs time to develop a new blood supply.

As with any surgery, there’s some risk of infection, bleeding, and scarring when you get fat grafting. In addition, two of the main risks are:

Too much fat reabsorption

Sometimes fat grafting doesn’t work well because the body absorbs too much of the fat that’s injected. How much fat survives depends on a lot of factors, including the technique used, how much fat was injected, your overall health, and your individual body and genetics.

Fat necrosis, oil cysts, and calcifications

Some of the transplanted fat cells may die and form scar tissue called fat necrosis. Others might  turn into fluid-filled sacs called oil cysts. Areas of fat necrosis and oil cysts often feel like firm lumps in the breast. Smaller ones may dissolve without any treatment, while larger ones may hurt or affect the breast’s shape and need to be surgically removed. Because a fat necrosis or an oil cyst can look or feel similar to a tumor, you may need testing to rule out breast cancer. There’s also a small risk that fat necrosis can make it harder for your doctor to interpret your mammogram results.

Some health insurance plans cover fat grafting when it’s done as part of breast reconstruction or to fix problems after breast reconstruction. Contact your insurer to find out the specifics of coverage under your plan. You and your plastic surgeon may need to provide documentation to your health insurance company that the procedure is medically necessary and not just cosmetic.

 

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This information made possible in part through the generous support of www.BreastCenter.com.