Fat Grafting

[olganyc]

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?

[Nurse4u2day]

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

[olganyc]

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!

[Jackie07]

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.

[Jackie07]

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.

[Lani]

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.

[Paula O]

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

[Catia]

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.

['lizbeth]

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.

[Shar]

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

[Catia]

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!

[Shar]

thank you. will do!

[Debbie L.]

Thanks (as always), Lani, for all the good information. It seems like the plastic surgeons have a bit of tunnel vision, reporting mostly on cosmetic results, while the oncologists are more cautious, advising we wait for more safety data (no increase in recurrence).

Here's a 2015 abstract:
Tissue-engineered breast reconstruction with brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience

If anyone has access, it would be interesting to see the full text. For example, I'm curious about the details of the cancers in the study (stage, etc). There is also a discussion piece on this article that isn't visible without subscription, and I'd love to see that. With a mean follow up of 2.5 years, this study is one of the longest I've seen -- other studies concluded it's "safe", with only 6 months of F/U, which seems a little hasty, to me.

Debbie Laxague

[Heathcliff4]

Fwiw, my surgeon does do fat grafting and I have two friends who had it done with different surgeons at UCSF. Both said that the liposuction was very painful. One friend kept telling me that I should do it as it would make for a smoother look. However, one year out, she admits that she thinks all of the fat has reabsorbed and it wasn't worth it. The other friend said it wasn't worth it from the start.

My surgeon said he didn't think it would be worth it for me as he felt the aesthetic outcome would be almost the same. I appreciated his honesty and was actually relieved not to have the liposuction. I'm relatively small (5'4'' and about 125 lbs) and I think he was concerned about the amount he would be able to transfer. I also had radiation on one side, which could have made it a bit tricky.

I'm very happy with the result of my implant exchange. They look really good in a tee shirt and I can wear a bathing suit and look good too.

Good luck with your decision.

Kathryn

[lisaifobi]

Hi Shar

just wanted to see if you had any luck or hopefully any updates with your search.
been doing my research over the fast few months and have learned alot.

I called miami breast center and from what i understand Brava is only needed because the fat stem cells are not 'processed' in the lab or something like that. The processing of stem cells are not allowed in the us which is really disappointing. For reconstructive purposes i think it should be legal but that is a political discussion i guess.

So im looking outside the us and have found a clinic in Austria and Thailand that offer what i want. The problem is i dont even have a passport dont really travel. A drive to canada is possible i guess but im not sure if they have it. Do you?

Im hoping you or someone else has a better alternative. Any suggestions?