Breast Reconstruction And Fat Grafting, What’s Hype Vs Fact?

Fat grafting is getting a lot of attention throughout multiple disciplines. Within the field of plastic surgery it’s becoming more common to inject fat in the face and the breast. Fat grafting to the breast is controversial for breast augmentation, but finding a more main-stream role within breast reconstruction.

How does it work? The procedures involve traditional liposuction followed by processing the fat (usually washing and then isolating the fat), and then the fat is injected in the breast. Usually scars are small and minimal.

In the field of breast reconstruction there are potential uses for fat grafting to include adding fat for volume, to improve contour abnormalities, to ‘rejuvenate’ radiated skin, and even for total breast reconstruction. Here are our thoughts on each of these roles:

  • Fat grafting for volume – this can be done with implant reconstruction or after flap reconstruction. In general, modest (ex. 1/2 cup size) enhancements can be expected. Surgeons (and patients) have to understand that ‘more can be less’, in that overfilling may lead to more absorption of the fat than moderate filling.
  • Fat grafting to improve contour abnormalities – it’s common after any type of reconstruction to have contour abnormalities, particularly in the upper pole or in areas of previous scars. Injecting fat into these areas may improve the appearance of such abnormalities.
  • Fat grafting to ‘rejuvenate’ radiated skin – the outcomes with this are quite controversial, but fat does seem to have rejuvenative characteristics to soften the damage to radiated tissue.
  • Fat grafting for total breast reconstruction (done with the Brava Bra) – though this sounds attractive to patients (natural breast reconstruction without addition of long scars), it’s role is very controversial. For patients who want to go this route, they must be counseled that this is a long process, with multiple procedures, that mandates compliance with wearing a bulky external bra device, and in the end they may not have the desired result. We do not offer this in our practice, but have had patients who have elected to purchase the Brava Bra before fat grafting for volume.