I think fat graft and transfer for reconstruction of the breast (after removal for cancer or prophylactically) is an exciting development in plastic surgery.
I started doing fat transfer about two years ago. It is not perfect, and it has its limitations, but for some patients it is ideal. I love using your own tissue to reconstruct the breast; I love the low rate of complications; I love the improvement seen in sensation and irradiated skin; and I love the liposuction benefit for those who have love handles or other areas they would like to reduce.
The ASPS (our national society for board certified plastic surgeons) recently approved their 2012 “post mastectomy fat graft / fat transfer guiding principles” as developed by their Patient Safety Committee. This was an update and replacement of their 2009 recommendations. They do issue a disclaimer stating “these guiding principles should not be construed as a rule and are not meant to serve as the standard of medical care.”
That is a lot of wording which states fat transfer is not the standard of care for breast cancer reconstruction. But what follows shows they are starting to endorse it as a viable option.
- Scientific evidence: The evaluation of literature for mastectomy (no breast tissue remains) suggests autologous fat transfer is an effective option for breast cancer reconstruction following removal of the breast. It demonstrates moderate to significant aesthetic improvement.
- It has also been found to help post mastectomy pain syndrome
- It improves the quality of radiated skin
- Risks & Complications: Relatively low complications are found. Complications include: bleeding, calcification, fat embolism, fat necrosis, infection, oil cysts and volume loss of transferred fat.
- “Fat grafting to the post mastectomy reconstructed breast does not delay breast cancer detection or increase breast cancer recurrence.” When radiography is used (MRI, Ultrasound, mammogram) by experienced radiologists, the presence of oil cysts, calcifications, and fat necrosis is distinguishable from suspicious lesions.
- There is a growing body of evidence suggesting NO increased risk of complications when fat transfer is used in previously radiated tissue.
- Technique: There is no standardization, but there are descriptions of fat graft harvest, preparation, and injection.
- For breast cancer reconstruction the number of fat grafting sessions varies per patient. The majority of patients require more than one session. (We normally quote 3-5 sessions, particularly if previous irradiation.)
I think this is an exciting development. Our national society is starting to endorse fat transfer as a viable option in our toolbox of reconstructing the breast. This is still a new frontier. But an exciting one.