Fat Grafting in Breast Reconstruction – What You Need To Know
By: Dr. Minas Chrysopoulo
Fat grafting, as a technique, has been around for many years but has recently experienced a resurgence in breast surgery. The procedure involves liposuctioning fat from one part of the patient’s body, purifying it and then injected into the breast.
Fat grafting can be used to fill-in partial breast defects after a lumpectomy. It is also frequently used after mastectomy, usually in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results. In patients having mastectomy without reconstruction fat grafting can improve the soft tissue coverage over the chest wall and create a more even contour.
There are several fat grafting techniques that are used by plastic surgeons. There is no “set way” that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells (and fat stem cells they contain) must be optimized to obtain the best long-lasting results.
Studies have also shown that once the injected fat “takes”, it can also help improve the thickness and quality of tissues and skin damaged by radiation.
Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.
For women still undergoing regular mammograms, it is important to know that fat grafting can also cause calcifications. As many of you have already unfortunately experienced, breast cancer can also cause calcifications. However, according to the American Society of Radiology, the two types of calcifications are easily distinguishable. Having said that, I still tell my patients that fat grafting can potentially lead to the recommendation for further tests (such as a core biopsy) because of calcifications.
Injected fat can also become firm or create “oil cysts”. Fortunately these are becoming much less frequent as techniques are refined but again, both of these can cause “unnecessary” stress.
Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is oncologically safe. However, because the technique is fairly new, little long-term safety data is currently available.
Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.