Fat Grafting

[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 (*).
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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.

[Lani]

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

[Lani]

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