Fat Transfer for Breast Reconstruction

Breast Reconstruction

It is a scarless procedure as the fat is injected with a fine needle. Fat is harvested by liposuction in an area where the patient has excess fat. The fat is specially prepared and re-injected into the breast or mastectomy site.

As well as creating a new breast, it can dramatically soften any radiotherapy changes and improve existing scars and skin quality.

In patients who have had an implant reconstruction where skin cover is poor, causing wrinkles and ripples of the implant to become visible. Fat grafting is extremely useful in hiding these by increasing the thickness of the soft tissue cover.

It is not possible to inject large volumes of fat in one session, as there must be enough space to allow the fat to develop its own blood supply. Therefore, more than one procedure is often required to achieve the desired result. The end result of the transfer procedure(s) is permanent.

Fat transfer (fat grafting or lipofilling) to breasts is a dynamic procedure, which has gained immense popularity to augment various parts of the body. The therapeutic effect of stem cells present in fat cells is an additional benefit that has an emerging role in tissue regeneration and wound healing.

What does the operation involve?

The technique involves aspirating and collecting fat through a small diameter cannula. The harvest technique is the same as for liposuction. You can select the donor site, but it is best taken from an area of diet resistant fat such as the abdomen, hips or thighs.

The fat aspirate is processed in a specialised collector to remove blood, oil and excess water. This leaves concentrated fat cells, which are then gently re-injected into the targeted area to increase volume and correct contour abnormalities or irregularities.

The procedure takes approximately one hour to perform, under a general anaesthetic (you will be fully unconscious). This is normally carried out as a day case, so you do not need to stay overnight in the hospital. However, if you have the fat grafting as part of another surgery you may be required to stay in hospital a little longer.

What are the risks and side effects of surgery?

Having surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of these potential problems.

Scars

Apart from a needle mark, like having blood taken, there will not be any scars. The scars at the donor site are approximately 3mm in size. These are hidden in the skin crease and should be barely perceptible. However, some patients heal with noticeably thickened, thin or stretched scars.

Bruising and swelling

This is very common on both the recipient and donor sites and the bruising may take a couple of weeks to settle.

Contour irregularities

It is possible to have indentations or laxity of the skin following this procedure. Massaging the area(s) should resolve this but occasional further surgery may be required.

Infection

This is rare, but I prescribe a course of antibiotics after surgery to reduce the risk of any infection.

Fat necrosis

If some of the fat does not receive a blood supply it will die and gradually be re-absorbed. This can sometimes leave a lump that cannot be seen but can be felt. Massaging should resolve this but occasionally a procedure to remove the lump may be required.

Fat loss

Of the fat that is injected, 40% to 70% of this should ‘take’ and become permanent. The remaining fat will simply melt away (re-absorb) over the next few weeks. If at this stage, you would like more volume, this can be performed approximately 12 or more weeks later.

Fat cysts

After fat transfer, these can sometimes occur. Most cysts can be aspirated with a needle if they are problematic.

Fat embolus

This is the obstruction of blood vessels by fat droplets. It is uncommon, but most often happens after fractures of long bones and may also arise in the post-operative period of orthopaedic surgeries. However, it has been described after liposuction and fat grafting. The cases of fat embolism from fat grafting have been linked to operations on the face and buttocks. In some reported cases, have been fatal. This is likely to be due to the rich blood supply and inadvertent damage to blood vessels.

Breast cancer development

There are theoretical concerns with regards to the possible effects of fat transfer on the development of breast cancer. However, to date, there is no evidence that fat injected into the breast causes cancer.

Thousands of fat transfer procedures have been performed worldwide, many in breast cancer patients, and an increase in breast cancer rates in these patients have not yet been recorded. However, it will take many years (with thousands of patients having had fat transfers to their breasts) before the scientific community will be able to accurately determine from robust data, if breast fat transfer contributes to breast tumour growth.

Breast imaging

Concerns have been raised that fat transfer can alter the appearance of the breasts on mammogram, ultrasound, and MRI scans.

Breast lumps, cysts, and calcifications can occur after fat transfer to breasts, just as they can after any other breast procedure.

The developing consensus is that transferred fat looks distinct on breast imaging and is generally distinguishable from suspicious lesions for breast cancer.

Further fat transfer procedures

These are sometimes required to give the desired result as only a certain amount of fat can be injected during one operation. If you would like more volume, this can be performed any time after 12 weeks post-surgery.

Further liposuction

This may be necessary to give the desired result. Only a certain amount of fat is removed at one operation (1 litre maximum). However, if you wish additional liposuction, then this can be performed at the same time.

Damage to internal structures

Liposuction is performed in the superficial layer of fat underneath the skin. As the cannulas are blunt, they are very unlikely to damage any important structures. However, if there is a hernia or weakness of the abdomen, then damage may be possible; this is very unlikely.

DVT/PE

Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

What happens after the operation?

Your incisions used for fat harvest are closed with dissolvable sutures, which do not require removal. I use a waterproof dressing, which will be removed after one week when everything should have healed.

You can shower as soon as you like after surgery, and you will be given spare dressings in case they become wet and need changing. I do not recommend bathing or swimming for 1 week after surgery.

I will prescribe you a 5-day course of antibiotics to be taken after surgery to reduce any risk of infection. Usually only simple analgesia such as Tylenol and Ibuprofen are needed in the initial post-operative period.

I recommend that you wear a support bra for 6 weeks post-operatively. You will need to purchase 2 of these, as you will want one to wash and one to wear. You will be advised as to the type and size of bra to purchase prior to surgery, by my nurse, who will give you the information you require. The garments can be purchased from the Hospital, or you can supply your own garments if you find it easier. One of the support bras will be applied on conclusion of the operation, so that you wake up wearing it.

Initially, your breasts may seem larger than you expected. This is normal and it is partly due to swelling as it takes time for everything to settle. The volume is likely to reduce as the swelling and bruising subsides and some of the fat is absorbed.

It takes approximately 12 weeks to assess the final result of your surgery. If at that stage you would like more volume, this can be performed approximately 12 or more weeks later.

Before you are discharged from Hospital you will be given a follow up appointment to see the nurse after one week post-operatively.

You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for advice.

Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection. The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

What is the estimated time for recovery, absence from work and return to usual activities?

You should take things easy for the first week and most patients return to work by 1 week. You can drive from as soon as you are comfortable, which is normally between 1 to 2 weeks. Most patients return to the gym at 2 weeks, and I recommend you wear your support bra for 4 weeks.