Fat grafting, also known as lipofilling or autologous fat transfer, is a surgical procedure that moves fat tissue from one area of the body to another. This technique is increasingly used in breast reconstruction, offering a natural tissue alternative to synthetic materials. The fat is typically harvested from areas like the abdomen, thighs, or buttocks, prepared, and then injected into the breast region. The primary focus is to correct defects that arise after breast cancer treatment, such as post-mastectomy or post-lumpectomy correction.
The Role of Fat Grafting in Reconstructive Goals
Fat grafting serves several specific purposes in breast reconstruction beyond simple volume addition. It is particularly valuable for correcting contour irregularities, such as dips or indentations, that can appear after surgery or radiation treatment. This process helps to smooth the overall shape of the breast mound, creating a more seamless and natural transition.
The technique also improves the quality of damaged tissue because the transferred fat contains adipose-derived stem cells with regenerative properties. Injecting fat into areas previously affected by radiation or surgery can soften hardened scar tissue, reduce pain, and increase the flexibility of the skin envelope. Fat grafting is often used as an adjunct procedure to complement other reconstruction methods, helping to camouflage implant edges or refine the final shape.
The Three Stages of the Procedure
The process of fat grafting is divided into three stages: harvesting, processing, and placement. The first stage, harvesting, involves gently extracting fat from a selected donor site, usually the lower abdomen or inner thighs. Surgeons use specialized, small-bore cannulas and low-pressure suction techniques to minimize trauma to the fat cells, as damaged cells are less likely to survive the transfer.
The second stage is the purification of the harvested tissue. The goal is to separate the viable fat cells (adipocytes) from impurities like excess fluid, blood, and cellular debris. Common techniques include centrifugation or simple washing and filtration methods. Removing these non-fat components is necessary because they can trigger inflammation at the recipient site, negatively affecting graft survival.
Finally, the purified fat is reinjected into the breast area during the placement stage. The surgeon uses a thin cannula to deposit the fat in small, linear droplets throughout the subcutaneous tissue. This technique, often described as creating a grid pattern, ensures that each tiny parcel of fat has close access to a blood supply. Maximizing surface area contact is crucial for the long-term survival of the transferred cells.
Determining Patient Suitability
Candidacy for fat grafting depends on the patient’s individual anatomy and reconstructive needs. The primary requirement is the availability of sufficient donor fat, typically extracted from the abdomen, flanks, or thighs. Patients who are very lean or have a low body mass index (BMI) may not possess enough harvestable fat for a significant volume increase. The quality and distribution of fat stores are often more important than a specific BMI number.
Fat grafting is generally best suited for minor to moderate volume restoration and contour correction, rather than creating a large new breast mound. For a successful outcome, the recipient breast tissue must be able to support the new graft. Although fat can improve the quality of previously irradiated skin, prior radiation exposure may reduce the percentage of fat that ultimately survives the transfer.
Post-Procedure Recovery and Volume Retention
Immediately following the procedure, patients can expect bruising, swelling, and soreness at both the donor and recipient sites. Discomfort is usually more noticeable where the fat was harvested due to the liposuction. Swelling in the breast area typically subsides within the first three weeks, though donor site swelling can sometimes last for several months. Patients are advised to wear compression garments to help reduce swelling and support the healing tissue.
The long-term success of the procedure hinges on volume retention, which is the percentage of transferred fat that permanently survives. A portion of the injected fat is reabsorbed by the body in the months following the surgery. Retention rates typically stabilize around 50% to 75% of the injected volume after about three to four months. Because of this predictable volume loss, multiple sessions, spaced several months apart, are often necessary to achieve the final desired contour and volume.