Breast Reconstruction Surgery: Fat Grafting
Fat grafting is used as an adjunct to breast reconstruction to perform ‘touch-ups’ and improve results
- In implant based reconstruction fat grafting may be used:
- To improve hollowing that can commonly be noticed in the cleavage area above the implant – this is because the mastectomy is often more extensive than the breast foot print in order to remove as much breast tissue as possible
- To improve implant visibility or rippling
- To overcome the effects of radiation
- While radiation and implants generally don’t mix, and complication rates are as high as 30-40%, there is evidence that fat grafting of a previously radiated area can soften and improve the quality of skin
- This can be done before insertion of expanders or implants to increase the softness of the area so it will expand to accommodate a prosthesis
- It may be undertaken after expansion or implant insertion to soften, and improve the overall result
- In autologous (free flap) breast reconstruction fat grafting may be used:
- To improve hollowing that can sometimes be noticed in the cleavage area above the flap – this is because the mastectomy is often more extensive than the breast foot print in order to remove as much breast tissue as possible
- To improve symmetry
Fat Grafting for Cosmetic Surgery
Fat grafting may also be employed for cosmetic procedures such as:
- Buttock augmentation (‘Brazilian Butt Lift’) where liposuction is performed of the back and thighs, and the fat is used to augment the shape of the buttocks
- Breast augmentation – in persons lacking sufficient tissue in the breast cleavage area, and to camouflage the implant, fat grafting can be used in the inner (medial) part of the breast in conjuction with standard implant placement for breast augmentation
- Breast reduction/lift – patients with significant deflation of breast tissue, need xtra volume in the upper pole after a reduction/lift. This can either be achieved through the use of implants or via the use of fat grafting
Fat grafting has a wide range of applications, but as yet Dr Aggarwal does not offer fat grafting for pure fat based breast augmentation. This is because
- It is controversial what fat can do to a normal breast (ie can it precipitate cancer)
- If it forms lumps called fat necrosis this can create confusion and anxiety regarding breast cancer
- Calcification of the fat can make detection of breast cancer tricky
- It is time consuming and requires repeated procedures, making it dramatically more expensive than implant based breast augmentation
Procedure Snapshot
- Anaesthetic: GA by accredited anaesthetist (although minor fat grafting can be done under local)
- Time: variable depending on indication
- Duration of stay: Day Surgery (or overnight stay)
- Hospital: Offered at a private hospital where Dr Aggarwal works
- Medicare/Health fund rebate: Specifically there is no item number for fat grafting and therefore no medicare/health fund rebate. For reconstructive procedure it may be allowed as part of another procedure.
- Recovery: Generally quick. Most people can do most things at the end of the first week. There may be some bruising in the area of fat injection and also from where fat was taken. Best to avoid swimming in a pool or beach for 2 weeks.
- Results: Touch ups with fat grafting in breast reconstruction can achieve excellent results. The procedure is a little unpredictable as only 50% of the fat survives the transfer, and therefore final results vary from patient to patient. Ultimately some degree of asymmetry is always to be expected (especially when trying to match a reconstructed breast to a native breast).
Procedure Information
- Minor liposuction is performed from an area where there is sufficient fat for harvest – the most common sites are abdomen, inner and outer thighs or buttocks
- The fat is collected in a sterile fashion, prepared and transferred to appropriate syringes for injection
- The fat is then carefully injected into a the breast taking care to make sure it is surrounded by tissue with good blood supply.
- In general approximately 50% of the fat grafted survives the transfer, which means the procedure may need to repeated on more than one occasion to achieve the desired result.
- Dr Aggarwal will place waterproof dressings over the incisions.
- You should wear a sports bra or crop top for the first 6 weeks. This helps to reduce swelling, pain and discomfort in the early post operative period as the area heals.
- You will be able to get the area wet after 48 hours and go back into your crop top or sports bra after your shower. You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery. This could be a little longer is there are wounds that are slower to heal.
- You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
- You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
- Unless your surgery was under pure local anaesthesia you will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look afer you for the first few days as you recover. You should not drive for at least 24 hours after having an anaesthetic nor operate heavy machinery.
- While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure.
- Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do.
Risks & Complications
- Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. For risks of breast augmentation click here.
- The risks of fat grafting include
- Incomplete correction – approximately 50% of the fat grafted survives the transfer
- Need for repeat procedure
- Fat necrosis – if a large lump of fat is injected the centre of the fat globule may not survive as it is not in contact with vascularised tissue (ie tissue with blood supply) and can form a hard lump. Therefore during fat grafting Dr Aggarwal is careful to inject small smount of fat in different planes to reduce the chances of this.
Procedure FAQs
- It is advisable to obtain a referral for fat grafting as it is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
- A Medicare/Health Fund rebate may apply to you depending on your level of cover, and having a referral allows you to claim this.
- You can see Dr Aggarwal at the main rooms in Gordon, and he also consults at Hornsby, Hunters Hill and Camperdown.
- Please scroll to the bottom of the page to find out more information about these locations
- At any of the hospitals where Dr Aggarwal works.
- Stop smoking well in advance of surgery. The risk of fat necrosis, infection and wound healing problems increases significantly in patients who smoke.
- Cease fish oil, and other supplements such as Ginkgo, Ginseng.
- Please discuss with Dr Aggarwal if you are on blood thinning medications
- No but you are advised to wear a tight fitting crop top or sports bra for at least 6 weeks.
- You should not wear any bras with an underwire during this period
- You should refrain from exercise for a few days following fat grafting.
- Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
- Repeat rounds of fat grafting may be needed to achieve the desired result.
- Yes it is safe to travel after fat grafting.
- However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.
- Not for 2 weeks to allow all wounds to heal.
- You can drive after 24 hours if you have had sedation or general anaesthetic for your fat grafting procedure.
- In bilateral reconstruction, general no.
- A mastectomy is more than 95% successful in removing breast tissue.
- Because no or minimal breast tissue is left behind there is usually no further imaging required for breast cancer screening.
- However you should discuss ongoing surveillance with your breast surgeon who is likely to see you on an ongoing basis for clinical examination and monitoring.
- For unilateral (one sided) reconstruction, you should participate in regular screening for the opposite native breast.
- Fat necrosis, if it occurs, can create a lump in the breast and cause confusion with breast cancer. Imaging of fat necrosis can usually easily pick the difference to a lump caused by breast cancer
- Calficiation of transferred fat was thought to cause confusion with breast cancer but imaging features of fat necrosis calficiation differ from calcification of breast cancer lesions so radiologists are usually able to tell them apart.
Procedure Pricing
- A Medicare item number usually does not apply to pure fat grafting procedures, although when used for reconstruction it may be allowed as part of a bigger procedure
- The out of pocket costs therefore vary depending on the extent and length of procedure, and what are other procedures are being performed.
- Fees quoted for fat grafting are exclusive of:
- Preoperative consultation fees – which are $250 for the initial consult and $125 for additional preoperative consultations
- Fees for the breast surgeon for mastectomies
- Other procedures such as opposite breast modification (breast lift/reduction), nipple reconstruction, and scar revision.
- Public patients
- It is possible to have your surgery through the public hospital
- You should note that under Medicare or as a no gap patient (if insured) there are no out of pocket costs under this system.
- In return for free health care, please note that:
- You may get limited say as to when your procedure may be scheduled
- Your reconstruction will be performed by a plastic surgery registrar (under the supervision of Dr Aggarwal)
- Your follow up will be with the hospital in clinics with the registrars
- There is waiting list of 12 months for revisions of breast reconstruction
- Your standard of care will still be very good
- Public patients coming to Dr Aggarwal’s private rooms are charged our normal initial and follow-up consult fees.
- Please note that the above fees do not include
- Preoperative consultation fees – which are $280 for the initial consult and $140 for additional preoperative consultations
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