The Surgeon Minute

Reconstructing the Breast with Fat

Reconstructing the Breast with Fat

Fat transplantation is quickly becoming one of the most versatile tools in the toolbox for plastic surgeons. Positive results in breast, body and facial procedures that utilize fat transfer have generated a tremendous amount of interest. Most patients are very interested in the idea of having some of their unwanted fat transferred to somewhere else on their body that needs volume! Dr. Dan Del Vecchio, a board certified plastic surgeon from Boston and an expert in fat grafting discusses the benefits of using fat in breast augmentation and breast reconstruction.

By: Daniel Del Vecchio, MD
and Susan Kamyab
ThePlasticSurgeryChannel.com

Benefits of Transferring Fat in Breast Augmentation

Patients who had breast implants in their 20’s may experience breast deflation when they are in their 30’s.  The reason for the deflation is because the soft tissue that is over the implant can thin and often does, especially after the patient has gone through pregnancy.  Many times, you can actually start to see the implant.  This is called soft tissue failure.  Dr. Del Vecchio explains, “The implant is fine, the problem is the soft tissue is not covering it well enough.  If we can put fat over the implant, we can often get a really nice result.  We will be able to restore the patient’s breast tissue, as if she was in her 20’s again.”

In this particular procedure surgeons use liposuction to obtain fat cells from one part of the body, such as the abdomen or thighs, and use it for augmentation or reshaping of the breast.  According to the American Society of Plastic Surgeons, “88% of plastic surgeons who currently perform fat grafting to the breast said they use fat grafting for breast reconstruction techniques, and often apply fat grafting along with implants or flap procedures.”

wp2Who’s the Best Candidate for Breast Reconstruction?

There are certain patients who benefit best from breast reconstruction with fat. Great candidates are the young 35 to 45 year old woman who are BRCA positive and elect to have a prophylactic mastectomy on both sides so they can eliminate the risk of breast cancer.  Dr. Del Vecchio says, “Since they have not had radiation, you can do a subcutaneous mastectomy and in some cases spare the nipple.”  The skin envelope, nipple, and muscle are still accessible, which means at the time of the mastectomy, surgeons can place fat directly under the muscle with little risk of the cancer returning.

On the other hand, the least attractive candidates for fat transplantation in breast reconstruction are the lumpectomy patients.  “On average, more than 1 and 8 lumpectomy patients will have cancer again,” says Dr. Del Vecchio. “If you’re injecting fat in a breast that’s at a higher risk of cancer, you’re more likely to have a recurrence, even though the fat doesn’t have anything to do with whether or not the cancer will return. ”

Get Comfortable with Fat

The average number of surgeries that a woman with breast cancer requires is about two and a half.  The issue is getting patients and surgeons comfortable with the techniques and concepts of getting fat to survive. Dr. Del Vecchio explains, “Once surgeons feel comfortable about the process of fat grafting and keeping the fat alive, I think you will see a big increase in the adoption of the breast reconstruction with fat operation.”

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