Should you have Fat Transfer during your explant surgery or after?
I have had extensive experience over many years performing breast reconstruction and fat transfer both for women after mastectomy and during explant surgery to rebuild their breast loss. I have seen many good results in terms of fat retention, safety and aesthetics when fat grafting is performed simultaneously during capsulectomy/explant and breast lift surgery. However it is important to note that each case deserves their own evaluation and each case is highly individualized.
The advantages of fat grafting at the time of explant surgery include increasing blood supply to the breast, creating a better structure and shape for the breast, minimizing indentations, hollows, shadows and concavities after explant, and prevention of skin retraction and tethering to deeper structures. In some cases it may be more difficult to expand the breast with fat grafting after it has contracted after explant surgery.
The trauma of explant surgery or breast reconstruction surgery does not decrease the success of fat grafting if it is done properly and in the correct amounts.
Concerns about Fat Necrosis and formation of Oil Cysts
Many women are concerned about hardening of fat (necrosis) or oil cysts after fat grafting. This is not a common occurrence when fat grafting is performed using fat that has been harvested with small cannulas, and injected under low pressure in an evenly dispersed pattern in tiny droplets.
This is a time consuming process that I do entirely by hand without pressure pumps.
If fat necrosis or oil cysts occur they do not pose health risks and do not cause cancer but may be noticeable to the touch. It is possible that injecting large clumps of fat graft will result in fat that does not get adequate blood supply. This can result in firm nodules (fat necrosis) or oil cysts that can be felt under the skin. While small cysts can be drained with a needle, larger nodules may need to be removed by excision.
Sometimes it is worth waiting to see if it resolves without treatment, especially if it’s small and not causing you discomfort. It can take several months for the breast fat necrosis to break down and for the cysts to disappear.
If you find any nodule or lump in your breast, report it to your plastic surgeon, undergo examination and then a decision will be made if an ultrasound is needed for clarification and peace of mind.
Does Fat Grafting cause SAGGING of the breasts?
Fat graft does not cause sagging of the breasts. Do not confuse volume deficiency with excess skin and descent of the nipple position. The latter is an indication that may require skin tightening/lifting (mastopexy).
In case of volume deficiency, fat grafting can help increase the volume and improve projection, but will not elevate the descend nipple-areola. It is very common in my practice to perform simultaneous Breast Lift and Fat grafting immediately after capsulectomy/explant.
Tell me more about Fat grafting Round 2
Sometimes it is necessary to have a second round of fat grafting to achieve the desirable volume. The procedure is simple and short.
All it takes is a simple pinhole access point to harvest fat from donor sites and inject fat to the breast. Minimal sutures or scars, no drains involved. This procedure typically takes about 60 minutes and the down time is 1-2 days before you can resume all activities.
Natural breast augmentation with fat is a process of building the volume with fat cells in the breasts and therefore it may take 1-3 rounds depending on the individual’s condition and goals.
To read more about Fat Transfer to the breast, facts, risks and benefits click here