Fat Transfer for Breast Reconstruction

What is fat transfer to the breasts (lipofilling)?

Fat transfer is minimally invasive surgery, which can be used to:

  • Fill a defect from a wide local excision/lumpectomy.
  • Improve soft tissue cover for implants.
  • Create a breast without implants.

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.

Fat grafting is tailored to the areas requiring additional volume and it can be used to shape the breasts in a way that implants cannot.

The whole concept is based on ‘structural fat grafting’. Fat cells injected by this special method lie in different tissue planes and can receive an individual blood supply. This results in the injected fat remaining for the longer term.

It is estimated that between 40% to 70% of the fat injected survives long-term, for which we overcompensate at the initial surgery. However, there is a maximum amount of fat that can be injected in any one procedure, therefore further sessions may be required.

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.

Having surgery should be a very positive experience. Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me.

Decisions about plastic surgery should never be rushed.
These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

  • Unintended intraoperative awareness, which is very rare.
  • Dizziness and nausea.
  • Sore throat.
  • Damage to teeth or mouth.
  • Nerve injury due to body positioning.
  • Allergic reaction or anaphylaxis.
  • Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

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.

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

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.

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.

To my knowledge there are no reports of fat embolus in fat grafting to breasts, but it is a potential risk with any fat grafting procedure.

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.

Deep Vein Thrombosis/Pulmonary Embolism (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.

All the risks outlined above will be discussed in detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

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.

Scar 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.

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.

For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.