Fat Grafting Procedure

New Zealand Herald article

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Recent Advances

We have been developing the technique of transferring and micrografting fat in larger volumnes for breast surgery.
Improvements continue to occur in all of the areas of the process, including:
  • Selection of cells for transfer
  • Harvesting techniques
  • Cell support mediums outside the body before transfer
  • Cell separation
  • Grafting placement
The outcome is now a very reliable method with more than 80 percent fat retention in most cases and the ability to move the breast two cup sizes in many cases in one sitting.
The method works very well for correction of small breasts, asymmetric breasts, loss of breast tissue after pregnancy.
The use of the BRAVA expansion technique is now limited to cases of severe asymmetry and is no longer necessary in the majority of cases, which simplifies the process.
We are also developing improved methods of breast reconstruction after cancer treatment, avoiding major flaps where possible and, when these are necessary, avoiding the sacrifice of any major muscles.
The main quest is adequate donor tissue availability which is not usually a problem.
Using fat cells in cases of cancer used to cause anxiety about the possiblity of a stimulating effect, but several large studies have established safety beyond all reasonable doubt.
There are some cancer surgeions in the UK deliberately placing new fat around active cancers in order to limit the amount of breast tissue to be removed, particularly skin.
The relative lack of post-op problems has been our consistent experience.
 

The Procedure

The technique is minimally invasive and has the side benefit of utilising liposuction to harvest the fat from areas of your body with unwanted fat, e.g. thighs, buttocks, stomach.

The distribution of fat cells is carefully assessed and the best areas selected for transfer.

The grafting bed or the tissue bed the grafts are to be placed in is carefully assessed, as is the skin envelope.

Most cases do not need to use the BRAVA only in cases of severe skin envelope constriction is it considered.

Blood tests will be arranged and nutritional support for the transferred fat cells is discussed.

On the day after preparation and under anaesthetic the fat is harvested at reduced pressure with specialised small cannulas through tiny incisions. The fat is washed with special fluid, separated and centrifuged in a closed system before being prepared to be placed into the grafting bed.

Multiple passes are made with the cannula to transfer the fat to the breast. Small amounts of fat are deposited with each pass. Each pass is put in a different place.

Identifying the end point accurately has been a recant advance with increased take and larger corrections being possible.

Single dissolving stiches are placed to seal the tiny holes and dressings placed.

Typically the procedure starts at 8.30 am and leave theatre at around 2 pm. There are 3 position changes during this time and the anaesthesia is usually total intravenous for rapid recovery although it takes a week to be washed out of the system entirely.

A garment is worn on the legs and hips for 6 weeks and recovery to normal is seldom more than 2 weeks and often less.

Swelling of the breasts slowly subsides over three weeks and the final soft result is evident at 6 weeks. For cases of reconstruction further stages can be carried out any time after 3 months as fat grafting settles much more quickly than cutting operations.

Follow up is arranged, Skype can be used in the early stages of recovery and a later in-person review organised.