Breast Reconstruction with Autologous Fat Transfer
Introduction to breast reconstruction using autologous fat transfer (AFT)
Northland Plastic Surgery is leading the way with a scientifically-proven and more natural alternative to breast reconstruction for women following breast cancer surgery. The same no knife procedure can be used for breast augmentation, defect corrections and congenital asymmetries.
The technique has been developed by the highly respected and much published Dr. Roger Khouri, plastic surgeon at the Miami Breast Centre. David Crabb (retired plastic surgeon), trained with Dr Khouri and was the leading New Zealand surgeon trained in this procedure. David introduced this to Northland Plastic Surgery and Chris Powell now uses the same technique.
If there is sufficient skin following a mastectomy, then reconstruction can generally be achieved.
Advantages of augmentation using fat transfer vs conventional silicone implants
- No prosthesis / foreign body used
- No risk of implant rupture and leak of silicone
- No risk of capsular contracture
- No risk of Anaplastic Large Cell Lymphoma (ALCL)
- No risk of breast implant illness
- No ongoing “maintenance” of implants (ie changing implants every 10-15 years)
- No surgical incisions or notable scars
- More “natural” appearance
How is it done?
The procedure is performed with patient asleep. The technique is minimally invasive (no large cuts are made) and has the additional benefit of utilising liposuction to harvest the fat from areas of your body with unwanted fat, e.g. thighs, hips, inner knees and stomach. Buttocks are not usually used.
Small nicks (2-4mm) made in the skin through which fat is extracted or grafted. These require single stitches which are dissolvable.
The procedure is less invasive and less stressful on your body than other methods of reconstruction with a quick recovery time. Patients go home on the day of surgery or the following day.
Fat transfer process
Fat is harvested by gentle liposuction from the thighs, buttocks and stomach. Even slender patients do well with this procedure as we usually find enough fat cells. The fat is then processed and meticulously injected back into the breast. The fat then picks up a new blood supply in the breast and survives. Typically 65%-80% of the fat survives. The procedure typically takes 2-4 hours and patients will go home the same day or have one night’s stay in hospital. A support garment is ordered in advance of surgery and worn for 6 weeks.
What is the recovery period?
The breasts are usually not particularly painful but the donor sites can be sore for a day or two. Regular oral painkillers are usually all that is required. Depending on occupation patients are off work for 3 to 14 days.
Which patients is Autologous Fat Transfer breast reconstruction suitable for?
- Following breast cancer surgery: Most patients who have had part of the breast removed (lumpectomy) or all of the breast removed (mastectomy) will do well with this procedure.
In severe cases of scarring and tethering, scar revisions may be needed as a preliminary step. - Salvage following failed previous reconstruction: Implant failure or flap failure can be a good indication for AFT. Implants are removed and fat grafting can then be performed into the skin flaps and underlying muscle to complete the first stage.
- Breast Implant Removal: Implants placed for cosmetic or reconstructive reasons often require removal for a multitude of reasons. Autologous Fat Transfer is able to replace the volume whilst avoiding putting silicone implants back in. There is often sufficient lax tissue to complete a reconstruction with one round of fat transfer. For breast reconstruction after cancer, where there is more scarring, additional rounds may be required.
Who is breast reconstruction with Autologous Fat Transfer not suitable for?
- Smokers: Smokers have a poor capacity to regenerate tissue. We recommend that a patient stops smoking at least two months before the procedure and abstain completely throughout the process, and for three months after.
- Patients taking Herceptin® chemotherapy and other angiogenesis inhibitors: These prevent grafted fat from picking up a new blood supply and lead to a poor outcome. We recommend the process be started about one month after a patient completes their course of Herceptin treatment.
- Patients taking aspirin (and over-the-counter food supplements and vitamins that may impair blood clotting): It is imperative that if possible the patient stops aspirin, all vitamins, and all herbal supplements at least two weeks before the procedure as these may impair successful fat grafting.
Reach out to Northland Plastic Surgery by phone, email or book in an assessment via Zoom.