Our breast cancer reconstruction world is changing. Dramatically. Now.
I just finished time in Miami with Dr. Khouri where I was able to see breast reconstruction using fat grafting. The results are amazing. Soft, natural breasts. Jiggly. Sensate. All you, your fat, moved from where you don’t want it to where you do. It works in radiation fields and improves the skin quality after radiation. The skin discoloration and firmness reverses back to near normal. Indented tethethered scars can be released.
This is not magic. It uses basic science and “low tech” instruments. It is part of what I love about it. This technique makes sense to me.
Wow what you can do.
Who is a candidate?
- Anyone who has had a mastectomy defect.
- First stage can be done with your mastectomy (immediate reconstruction) or delayed (after you are done with all of your treatments).
- You can have had radiation. This makes the grafting harder, so it takes 3 surgeries to get to the point you would have been at if you had not had radiation.
- You can have had prior reconstruction with an implant. Women who have failed implant reconstruction for capsular contracture, infection, migration, “implant cripples” are good candidates.
How?
Fat grafting for breast reconstruction is not a one surgery operation. I know the idea of multiple surgeries is offputting for many, but those who know breast reconstruction know tissue expander implant reconstruction is not a one stage thing, and usually free flap reconstruction has small touch ups (or big ones if needed).
- It takes multiple steps over months. This varies if you have had radiation, if this is immediate or delayed, how much volume you need, etc.
- There are usually 3 -5 surgeries, spaced 2-3 months apart.
- Only the mastectomy is an in patient procedure. The rest are done outpatient.
- The patients I saw were mobile and returning to life faster than what I see with implant reconstructions.
- You need to do some prep work. See my upcoming blogs on BRAVA. From what I have seen with patients in various stages of reconstruction, the more compliant you are with BRAVA, the faster you get to your reconstruction being done.