Fat Grafting
 

Dear Ladies,

does anyone has experience with fat grafting for breast reconstruction after mastectomy?
I consider this option for myself, but it seems that it is not very well researched and not too popular (none of the plastic surgeons I saw even mentioned it).
However, it sounds nice - natural feel and no scar (and a free lipo :))

what is your experience with it?

Re: Fat Grafting
 

Hello olganyc,
I am going to have what they call a DIEP for my reconstruction in Nov. This is where they will take my fat and skin from abdomen ( no muscle) and make me a new pair of boobies. So basically I get a boob job and a tummy tuck all at the same time. I know not every state does this as it is specialized . I'm getting mine done at Stanford hospital near San Fransisco.
Only certain plastic surgeons do this as it is somewhat new and very specialized. My understanding is that if your state doesn't offer it ( no docs to do it) that the laws say insurance has to pay for you to see out of state doc( not traveling cost just md cost)
I am 45 and a mother of 2 and rather like having boobs and hey a flat tummy to go with

Re: Fat Grafting
 

Thank you.
I thing that fat grafting is different from DIEP or another flap - they suck the fat out by liposuction, centrifuge it and separate it from liquid, and inject to form a breast mound. It takes several procedures.
I am exploring this option and looking if anyone went through it.
Good luck with your procedure!

Re: Fat Grafting
 

Here's an abstract on the subject:

Plast Reconstr Surg. 2014 Jun;133(6):1369-77. doi: 10.1097/PRS.0000000000000179.
Megavolume Autologous Fat Transfer: Part II. Practice and Techniques.
Khouri RK1, Rigotti G, Cardoso E, Khouri RK Jr, Biggs TM.
Author information
Abstract
SUMMARY:
The authors describe the techniques that use the principles of fat grafting to allow them to successfully graft megavolumes (250-ml range) of autologous fat into breasts. The Brava external volume expansion device preoperatively increases the volume and vascularity of the recipient site. Low-pressure liposuction and minimal centrifugation are used to gently extract and purify the adipose tissue with minimal trauma. Even and diffuse reinjection of the fat increases graft-to-recipient interface and reduces interstitial fluid pressure. Postoperative Brava use protects the graft and acts as a three-dimensional immobilizing splint. By adhering to these techniques, we have been able to graft megavolumes of fat into the breasts of over 1000 patients and obtain substantial long-term volume retention.

Re: Fat Grafting
 

Another one showing it's a successful procedure:

Breast Cancer. 2014 May 29. [Epub ahead of print]
Fat grafting in immediate breast reconstruction. Avoiding breast sequelae.
Moltó GarcÃ*a R1, González Alonso V, Villaverde Doménech ME.
Author information
Abstract
BACKGROUND:
The remarkable increase that breast-conserving surgery has been experiencing throughout the last decades is as much undeniable as the imposition of the immediate reconstruction as the gold-standard treatment regarding breast reconstruction. Nevertheless, these trends conflict since we do not have a satisfactory immediate reconstruction method for breast-conserving surgery. This work shows the technique we have developed to solve this problem through autologous fat grafting ensuring the same oncological safety.
METHODS:
We present the preliminary results of 37 immediate reconstructions of lumpectomies and quadrantectomies through autologous fat grafting of lumpectomies. Patients have been chosen by a multidisciplinary committee following special criteria based on their low-risk pathology, having undergone different diagnostic tests previous to the resection and 1 year postoperative monitoring by qualified observers. Also, a satisfaction survey has been performed.
RESULTS:
In all cases studied, with a year follow-up, we found excellent aesthetic outcomes with no presence of the feared scar retractions and deformities, even after radiotherapy. According to patient surveys, the satisfaction rate was also very high. No important complications, either acute or chronic, have been observed from the implementation of this technique.
CONCLUSION:
This is a useful, innovative technique, having good aesthetic results, decreasing the incidence of aesthetic sequelae, commonly seen in simple lumpectomies without reconstruction. The complication rate is low, and oncological safety is not compromised.

Re: Fat Grafting
 

Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 67, Issue 5, May 2014, Pages e127–e128

Cover image
Correspondence and communication
Recurrence of invasive ductal breast carcinoma 10 months after autologous fat grafting
J.M. Smit, H.J.P. Tielemans
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DOI: 10.1016/j.bjps.2013.12.043
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Referred to by
B. Chaput, J.L. Grolleau, N. Bertheuil, H. Eburdery, J.P. Chavoin, I. Garrido
Another suspected case of breast cancer recurrence after lipofilling? Remain cautious …
Journal of Plastic, Reconstructive & Aesthetic Surgery, Available online 28 March 2014,
PDF (139 K)
Dear Sir,
Lipofilling has been carried out in aesthetic surgery worldwide for many years and, more recently, in breast cancer patients to improve the results of breast reconstruction.1 and 2 While numerous published clinical studies have highlighted the advantages of this procedure, it remains of importance to be aware that it might also have potential down sides. With this in mind we like to report the following case.

It concerned a 44-year old female who had undergone a right modified radical mastectomy due to grade II invasive ductal carcinoma followed by radiotherapy in 2006. In 2009 the same surgical procedure was performed on her left side, followed again by radiotherapy, because of a lymphangitis carcinomatosa. In both cases she received neo-adjuvant chemotherapy. In that same year, a BRCA2 gene mutation was diagnosed. In 2011, she first came to our department because of pain and tightness of both her mastectomy scars for which lipofilling was proposed. In one year time she underwent two lipofilling sessions in which in total 150 cc fat was injected per side. This reduced her complaints.

In 2013 she returned to our outpatient clinic due to a skin rash around her right mastectomy scar. Biopsies showed a recurrence of the invasive ductal carcinoma for which surgery was indicated. Despite a margin of 2 cm and a partial resection of the pectoralis major muscle, the resection was incomplete and re-excision had to be performed. Radical resection of the tumour was achieved during a second procedure. The remaining defect was closed with a latissimus dorsi flap.

On histological analysis we observed invasive ductal carcinoma with extensive lymph angioinvasive growth and numerous tumour nests embedded in sclerotic stroma and often associated with subcutaneous (remnants of) fat necrosis, in particular oil cysts (Figure 1). Although it is not uncommon to see scleroplastic stroma around tumour nests, it is to see fat necrosis and oil cysts.

Full-size image (56 K)
Figure 1.
Histologic analysis of the mastectomy scar showed extensive and multifocal tumorrecurrence. This representative photograph (hematoxylin and eosin, x50) demonstrates subcutaneous tumordepositis (encircled) associated with subcutaneous remnants of fat necrosis, in particular oil cysts (*).
Figure options
In 2013, a similar case has been reported by Chaput et al.3 In their histological report they described tumour cells in trenches created by autologous fat grafting lipofilling. As in our case, it concerned an aggressive tumour that required multiple treatments.

With reporting these cases, it is not our aim try to suggest a direct causal link between lipofilling and the recurrence of breast cancer, but want to discuss the possibility of a synchronous recurrence to autologous fat grafting that may have been masked. Nonetheless, the risks of promoting a latent cancer or metastases are not excluded, especially when taking these histological findings in consideration.

It is our opinion is that lipofilling offers many advantages in breast reconstruction and the cosmetic refinements afterwards, but controversy remains.4 Until the first outcomes are reported of the large prospective multicentre studies currently in progress about autologous fat grafting in breast cancer patients, these points will however remain open for discussion.

Conflict of interest
None.

Funding
None.

References
1
J.Y. Petit, V. Lohsiriwat, K.B. Clough et al.
The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study —Milan–Paris–Lyon experience of 646 lipofilling procedures
Plast Reconstr Surg, 128 (2011), pp. 341–346

View Record in Scopus | Full Text via CrossRef | Citing articles (1)
2
M. Rietjens, F. De Lorenzi, F. Rossetto et al.
Safety of fat grafting in secondary breast reconstruction after cancer
J Plast Reconstr Aesthet Surg, 64 (2011), pp. 477–483

Article | PDF (389 K)
3
B. Chaput, L. Foucras, S. Le Guellec, J.L. Grolleau, I. Garrido
Recurrence of an invasive ductal breast carcinoma 4 months after autologous fat grafting
Plast Reconstr Surg, 131 (2013), pp. 123e–124e

Full Text via CrossRef
4
J.Y. Petit, M. Rietjens, E. Botteri et al.
Evaluation of fat grafting safety in patients with intra epithelial neoplasia: a matched-cohort study
Ann Oncol, 24 (6) (2013), pp. 1479–1484

View Record in Scopus | Full Text via CrossRef | Citing articles (7)
Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Re: Fat Grafting
 

Breast J. 2014 Mar-Apr;20(2):159-65. doi: 10.1111/tbj.12225. Epub 2014 Jan 23.
Oncological safety of autologous fat grafting after breast conservative treatment: a prospective evaluation.
Brenelli F1, Rietjens M, De Lorenzi F, Pinto-Neto A, Rossetto F, Martella S, Rodrigues JR, Barbalho D.
Author information

Abstract
Autologous fat graft to the breast is a useful tool to correct defects after breast conservative treatment (BCT). Although this procedure gains popularity, little is known about the interaction between the fat graft and the prior oncological environment. Evidences of safety of this procedure in healthy breast and after post-mastectomy reconstruction exist. However, there is paucity of data among patients who underwent BCT which are hypothetically under a higher risk of local recurrence (LR). Fifty-nine patients, with prior BCT, underwent 75 autologous fat graft procedures using the Coleman's technique, between October 2005 and July 2008. Follow-up was made by clinical and radiologic examination at least once, after 6 months of the procedure. Mean age was 50 ± 8.5 years, and mean follow-up was 34.4 ± 15.3 months. Mean time from oncological surgery to the first fat grafting procedure was 76.6 ± 30.9 months. Most of patients were at initial stage 0 (11.8%), I (33.8%), or IIA (23.7%). Immediate complication was observed in three cases (4%). Only three cases of true LR (4%) associated with the procedure were observed during the follow-up. Abnormal breast images were present in 20% of the postoperative mammograms, and in 8% of the cases, biopsy was warranted. Autologous fat graft is a safe procedure to correct breast defects after BCT, with low postoperative complications. Although it was not associated with increased risk of LR in the group of patients studied, prospective trials are needed to certify that it does not interfere in patient's oncological prognosis.
© 2014 Wiley Periodicals, Inc.
KEYWORDS:
adipocyte stem cell; autologous fat graft; breast cancer; breast reconstruction; local recurrence

PMID: 24450421

Re: Fat Grafting
 

this review only applies to those who never had breast cancer:

J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):437-48. doi: 10.1016/j.bjps.2013.11.011. Epub 2013 Dec 12.
Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review.
Largo RD1, Tchang LA2, Mele V3, Scherberich A3, Harder Y4, Wettstein R2, Schaefer DJ2.
Author information

Abstract
BACKGROUND:
Fat grafting for primary breast augmentation is growing in popularity due to its autologous properties and its side benefit of removing unwanted fat from other areas, although volume gain is unpredictable and patient safety remains unclear.
OBJECTIVE:
The aim of this study was to provide an evidence-based overview of autologous fat grafting to healthy breast tissue with focus on volume gain, safety and complications.
DESIGN:
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
DATA SOURCES:
The MEDLINE, Cochrane Library and EMBASE databases were searched for clinical studies on autologous fat grafting to healthy breast tissue within the last 30 years.
DATA EXTRACTION:
Clinical articles were evaluated for indication, pre- and postoperative work-up, surgical technique, volume gain (efficacy), complications, radiographic changes and oncological safety. The level of evidence was assessed according to the Oxford Centre for Evidence-based Medicine 2011.
RESULTS:
A total of 36 articles involving 1453 patients with a mean follow-up period of 16.3 months (1-156 months) were included. No randomised controlled studies were found. Six percent of the patients undergoing fat grafting to healthy breast tissue experienced major complications requiring a surgical intervention or hospitalisation. Two patients with breast cancer (0.1%) after fat grafting for cosmetic purposes were reported. Average breast volume gain ranged from 55% to 82% relative to the grafted fat volume.
CONCLUSIONS:
The prevalence of complications and re-operations in fat grafting to healthy breast tissue compared favourably to implant-based breast augmentation. Although no increased incidence of breast cancer was found, long-term breast cancer screening and the implementation of publicly accessible registries are critically important to proving the safety of fat grafting.
Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Breast augmentation; Breast reconstruction; Cosmetic; Lipotransfer; Oncological risk; PRISMA; Systematic review; Volume gain

PMID: 24394754

Re: Fat Grafting
 

Ann Endocrinol (Paris). 2013 May;74(2):106-7. doi: 10.1016/j.ando.2013.03.002. Epub 2013 Apr 8.
Contribution of endothelial precursors of adipose tissue to breast cancer: progression-link with fat graft for reconstructive surgery.
Bertolini F.
Author information

Abstract
Obesity, an excess accumulation of adipose tissue occurring in mammalians when caloric intake exceeds energy expenditure, is associated with an increased frequency and progression of several types of neoplastic diseases including postmenopausal breast cancer. Recent studies have suggested that obesity-related disruption of the energy homeostasis results in inflammation and alterations of adipokine signalling that may foster cancer initiation and progression. Moreover, two populations of human white adipose tissue (WAT) progenitors cooperate in breast cancer angiogenesis, growth and metastatic progression. This raises the issue of lipotransfer in patients undergoing plastic or reconstructive surgery.
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
PMID: 23578485 [PubMed - indexed for MEDLINE]

Re: Fat Grafting
 

J Plast Surg Hand Surg. 2013 Sep;47(4):273-5. doi: 10.3109/2000656X.2012.759583. Epub 2013 Apr 30.
Autologous fat grafting and breast cancer recurrences: retrospective analysis of a series of 100 procedures in 64 patients.
Ihrai T1, Georgiou C, Machiavello JC, Chignon-Sicard B, Figl A, Raoust I, Bourgeon Y, Fouche Y, Flipo B.
Author information

Abstract
Autologous fat transfer (AFT) enhances the cosmetic results of breast reconstruction and corrects breast conserving operation sequelae. The question of its oncological safety remains, as in-vitro experiences have shown that adipocytes can stimulate cancer cell proliferation. This study analysed the records of patients who had AFT after breast cancer from 2004-2009. The primary end-point was cancer recurrence. The secondary end-points were AFT complications and post-AFT mammogram modifications. Sixty-four patients (100 AFT) were included. The mean follow-up for AFT was 46.44 months (SD = 21.4). Two breast cancer recurrences were recorded (3.1%). Among 55 mammograms analysed, only one patient presented radiological abnormalities. One complication of AFT (donor-site infection) was recorded. This series is in favour of the oncological safety of AFT after breast cancer. An accurate evaluation of the recurrence risk, before performing AFT, is an essential prerequisite and must lead one to postpone or avoid this procedure in high-risk patients.
PMID: 23627644 [PubMed - indexed for MEDLINE]

Re: Fat Grafting
 

Aesthetic Plast Surg. 2013 Aug;37(4):728-35. doi: 10.1007/s00266-013-0166-5. Epub 2013 Jun 29.
Oncologic surveillance of breast cancer patients after lipofilling.
Riggio E1, Bordoni D, Nava MB.
Author information

Abstract
BACKGROUND:
The regenerative effects of fat injections are based on the same hormones, growth factors, and stem cells that stimulate neoplastic angiogenesis and cancer progression in basic research. Few studies have analyzed the oncologic risk. No report has covered 5 years of oncologic surveillance, and no long-term risk has been estimated. The in vivo relationship between lipofilling and breast cancer remains unclear and controversial. This observational study focused on locoregional recurrence (LR) risk after lipofilling.
METHODS:
The study enrolled 60 patients after breast cancer surgery (total mastectomy) from 2000 to 2007 treated by lipofilling (82 single-surgeon procedures with the same fat-decanting technique). The study ended when follow-up observation reached 10 years.
RESULTS:
The study included invasive carcinoma (55 cases), in situ carcinoma (five cases), T1 (71.6 %) and T2 (23.3 %) carcinoma, N+ carcinoma (45 %), and stages 1 (43.3 %) and 2 (45 %) carcinoma. The overall 12-year incidence of LR was 5 % (1.6 % before and 3.3 % after lipofilling). The incidence of local relapse per 100 person-years was 0.36 in the first observation period and 0.43 after lipofilling. All LRs were stage 2, and the same rate, limited to stage 2, was 1.04. The crude cumulative incidence after lipofilling was 7.25 % (95 % confidence interval [CI], 0-15.4 %) for LR and 7.6 % (95 % CI, 0.2-15 %) for distant metastases.
DISCUSSION:
Clinical data and recurrence incidences were compared with those of prior publications concerning lipofilling oncologic risk and discussed in relation to the inherent cancer literature.
CONCLUSIONS:
Lipofilling may be used safely to treat tumor node metastasis stage 1 subjects after mastectomy. The local risk is low. For stage 2 patients, local failure was not significantly higher. Compared with institutional data and prior publications, the risk still is reliable. Breast conservative treatment must be investigated further because of the high risk for local relapse.
LEVEL OF EVIDENCE III:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Comment in
Discussion for oncologic surveillance of breast cancer patients after lipofilling. [Aesthetic Plast Surg. 2013]
PMID: 23812610 [PubMed - indexed for MEDLINE]

Re: Fat Grafting
 

Recurrence of an Invasive Ductal Breast Carcinoma 4 Months after Autologous Fat Grafting
Chaput, Benoit M.D.; Foucras, Lionel M.D.; Le Guellec, Sophie M.D.; Grolleau, Jean Louis M.D.; Garrido, Ignacio M.D., Ph.D.
Author Information
Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil (Chaput, Foucras)
Pathology Department, Institut Claudius Regaud (Le Guellec)
Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, Toulouse, France (Grolleau, Garrido)
Correspondence to Dr. Chaput, Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, 1 Avenue Jean Poulhès, 31059 Toulouse, France benoitchaput@aol.com

Sir:

Autologous fat grafting is widely used in reconstructive breast surgery but, more recently, is also being used in breast augmentation. For 20 years, the cautious recommendation of the American Society of Plastic and Reconstructive Surgeons was a real obstacle.1 Nevertheless, for a few years, we have witnessed a strong increased confidence in this procedure.

Graphic Figure. No caption a...
A patient aged 34 years was admitted for two breast nodules. Initially, a tumorectomy had been performed with insufficient exeresis margins. Thus, a mastectomy with axillary node dissection had been performed followed by chemotherapy and radiotherapy. Twenty-four months later, a reconstructive operation was started, the first step of which consisted of autologous fat grafting. At 4 months, during the expander's setting, the mastectomy scar was excised (Fig. 1). Discrete lumps and papular lesions had been noticed. Histologic analysis confirmed local recurrence of the carcinoma. Currently, the patient presents a metastatic invasion of the sternum.

Graphic Fig. 1
Radiographically, the studies in favor of a slight modification of the parenchyma are numerous, and a trained radiologist finds little difficulty in interpretation. The cancer issue is different. In vitro, the promotion of cancer recurrence and metastases has been demonstrated through the action of the adipose-derived stem cells, the neoangiogenesis, and aromatase.2–5 Nevertheless, these relations have never been highlighted in vivo. This can be explained by the actual rupture between the laboratory studies and those in humans.


We are attempting to authenticate not a real causal link but the possibility of a synchronous recurrence to autologous fat grafting that may have been masked. Nonetheless, the risks of promoting a latent cancer or metastases are not excluded. Moreover, this patient very quickly presented metastases. Histologically, it is interesting to note that the tumor cells were displayed along the trenches created during autologous fat grafting (Fig. 2). It is possible that either the cancer recurrence was already present and the cannula went in the tumor, participating in local dissemination, or the quiescent tumor cells resumed their development along the graft trenches. The extension to the sternum could also result either from the dissemination through the cannula or from the metastatic development of the tumor.

Graphic Fig. 2
On the international level, the behavior is not homogenous. In 2009, the American Society of Plastic Surgeons Fat Graft Task Force had concluded that no reliable study confirmed the absence of risk of cancer. In 2011, the French Society of Plastic and Reconstructive Surgery, which had strictly advised against breast autologous fat grafting since 2007, changed their position. The French Society is now suggesting autologous fat grafting as part of a clinical protocol. Currently, a prospective study is ongoing in France [Adipose Tissue Transfer for Moderate Breast Cancer Conservative Treatment Sequella (GRATSEC); http://clinicaltrials.gov/show/NCT01035268] in an attempt to provide answers with a high level of evidence regarding the uncertainties between autologous fat grafting and breast neoplasia.2


This case, atypical in its chronology and histology, enables us to raise the questions once more regarding this procedure and of its controversial characteristics on breast cancer. The absence of scientific evidence must lead us to remain vigilant, even nowadays. Information and regular patient follow-up remain essential in the long term with, if possible, a national compulsory registry to centralize the data.


Benoit Chaput, M.D.


Lionel Foucras, M.D.


Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil


Sophie Le Guellec, M.D.


Pathology Department, Institut Claudius Regaud


Jean Louis Grolleau, M.D.


Ignacio Garrido, M.D., Ph.D.


Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, Toulouse, France


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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.


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REFERENCES

1. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: Safety and efficacy. Plast Reconstr Surg. 2007;119:775–785; discussion 786–787. [Context Link]


2. Mojallal A, Saint-Cyr M, Garrido I. Autologous fat transfer: Controversies and current indications for breast surgery. J Plast Reconstr Aesthet Surg. 2009;62:708–710. Bibliographic Links [Context Link]


3. Pearl RA, Leedham SJ, Pacifico MD. The safety of autologous fat transfer in breast cancer: Lessons from stem cell biology. J Plast Reconstr Aesthet Surg. 2012;65:283–288. Bibliographic Links [Context Link]


4. Petit JY, Lohsiriwat V, Clough KB, et al.. The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: A multicenter study—Milan-Paris-Lyon experience of 646 lipofilling procedures. Plast Reconstr Surg. 2011;128:341–346. [Context Link]


5. Dirat B, Bochet L, Dabek M, et al.. Cancer-associated adipocytes exhibit an activated phenotype and contribute to breast cancer invasion. Cancer Res. 2011;71:2455–2465. Bibliographic Links [Context Link]


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Re: Fat Grafting
 

Dear Jackie07 and Lani,

thank you so much for all the research data!
It will take some time to sift though all the articles and form an opinion.
Seems that fat grafting takes a long time and the process is not rather unpleasant. I wonder how the resulting breast looks and feels in the long term.

I had an expander put in during the mastectomy, and later I heard about the fat grafting. I want to reconstruct, but I am uncertain about implants (water vs. silicone) and I am curious about the fat grafting procedure.
Need to make a decision pretty soon, and don't know which one!
appreciate your support

best regards

Re: Fat Grafting
 

Hi there,
I had the fat grafting done with the BRAVA. It took three procedures and the lipo was quite painful. I had it done with Dr. Khouri in Miami who invented the BRAVA supported fat grafting in order for the grafted fat not to die off. He is training hundreds of physicians in this procedure and you should call the Miami Breast Center and they will surely be able to tell you what physicians live nearby you that he has trained in this. It was also paid for by my insurance.

Re: Fat Grafting
 

Here's some info I gathered awhile back, olganyc that you might find of interest:

http://her2support.org/vbulletin/sho...ghlight=bravia
(the "i" in Brava in title is a typo)

I wonder if Brava has more or less fat necrosis outcomes than the other fat grafting surgeries.

Paula

Re: Fat Grafting
 

I had no fat necrosis at all and the MRI that I had 4 months after my last fat grafting did not indicate any cysts either, and yes, that's what the BRAVA does...it increases circulation and prepares the tissue to be ready for the fat to go in and live.

Re: Fat Grafting
 

That was interesting. Any studies that show who progresses and the characteristics unique to this person and their cancer is certainly welcome.

I was not surprised at the BRCA2 progression and the sternal lesion on the 34 year old.

It seems that AFT is a prudent option for those with a lower risk of recurrence. Perhaps those with a higher risk should chose other options until more advances with cancer treatments are part of standard of care.

Has there ever been similar studies analyzing TRAMS, LATS and DIEPS?

Paula - I would expect BRAVA to have less fat necrosis. It is a similar concept to the VAC that I wore for 5 weeks, vacuum assisted closure to help a pocket sized wound heal. It was a huge pain dragging a pump around for weeks but I have no necrotic lumps and I suspect it inadvertently increased the breast size in the area of loss.

Very happy to see the recent studies of AFT.

Re: Fat Grafting
 

Does anyone have information on the BRAVA/AFT procedure being used in Canada?

Re: Fat Grafting
 

Shar,
I would call Dr. Khouri's office at the Miami Breast Center. He is the one who invented the BRAVA and can tell you which Canadian physicians have trained with him.
Best of luck!

Re: Fat Grafting
 

thank you. will do!