Breast Fat Grafting After Cancer / Lipomodelling | Treatment planning and repeated sessions

In published techniques, fat is harvested with a blunt cannula after tumescent infiltration, then centrifuged or washed and decanted to separate purified fat from oil, blood and infiltration fluid. Only the middle fat layer is used. It is injected in small amounts through blunt cannulas into multiple breast planes, often after releasing scarred tissue. Because grafted fat must gain blood supply from the recipient site, some fat may not survive, and several sessions may be needed, especially after radiation. Only patients free of local breast disease are considered eligible, with clinical and radiological evaluation. Donor sites may include the abdomen, thigh, knee, flank or trochanteric area depending on patient characteristics.

Small aliquots increase contact with host tissue, improving blood and oxygen supply. Bolus injection is avoided because it can cause oil cysts, lumps, calcification, infection and lower graft survival. Large volumes may jeopardize vascularity and cause contour irregularities. In irradiated or reconstructed breasts, small amounts near the skin may help avoid total necrosis, with deeper placement in later sessions. Fat is not injected into glandular tissue. Injection method matters more than harvesting or processing. Coleman suggests about 0.25 cc per ejection. Several sessions may be needed, especially after radiation, because transferred fat must gain blood supply from the recipient site.

Fat grafting is usually an adjunct to correct contour deformities, rippling or volume deficits after mastectomy or lumpectomy reconstruction, and recipient-site capacity limits how much can be placed safely. Radiation makes tissue stiff and fibrotic, so less fat can be injected per session and more sessions may be needed. In one series, mean grafted volume was 211 cc per session and mean retention was 58.9% in ten patients; whole-breast reconstruction required a mean 600 mL over multiple stages. Some patients complete treatment in one or two sessions for contour refinement, while prior radiation usually needs three to six sessions after cancer treatment.

Radiotherapy causes fibrosis, making tissues tough and stiff, and reduces blood supply. Because transferred fat is a graft, it must gain blood supply from the recipient site; some fat survives and some does not. In irradiated tissue, injecting a small quantity improves fat take, while larger volumes are less feasible. The number of procedures relates to radiation damage severity, the amount of deep fibrosis and expectations; sources describe ranges from one to four, two to four, or typically three to six sessions. Sometimes resorption is higher after the first session, then engraftment may increase unpredictably as tissue regenerates. [, S5, S8, S14]

Fat is taken from another body area and injected into breast tissues. In implant-based reconstruction, thin mastectomy flaps can make implant borders or rippling visible; fat grafting may camouflage rippling and smooth the transition between chest wall and implant. It may be done during tissue expander-to-implant exchange or later after permanent implant placement. When fat is injected very close to an existing implant, implant replacement may be recommended to avoid cannula-related trauma. Eligibility also requires being free of local breast disease with appropriate clinical and radiological evaluation. Fat grafting may also correct contour deformities, improve radiated tissue quality, and several sessions may be needed.

Autologous fat grafting moves fat from another body area into the breast to correct contour deformities after lumpectomy or reconstruction. It is often an adjunct, and several sessions may be needed because some fat does not survive. It can be used before or after main reconstruction, and donor fat is usually taken from the abdomen or thighs. After breast-conservation therapy, benefits are less established; mammographic changes can create confusion, and radiated tissue may be less amenable. Only patients free of local breast disease are considered eligible, with appropriate clinical and radiological evaluation. Fat may also improve skin quality after radiation, but results vary and complete correction is not guaranteed.

Fat grafting adds volume to contour defects or the other breast for symmetry, but tethered scars can restrict filling. Scar release—percutaneous subcision or intraoperative release with specialized cannulas—separates scar from underlying tissue, helps prevent retraction, and allows fat placement. Post-traumatic asymmetry is treated after scars mature, about 6–24 months, when other methods are unsuitable; symmetrization may also include releasing tight scar tissue and finer fat grafting. Several sessions may be needed, especially after radiotherapy, because not all transferred fat survives and vascularity must be acquired from the recipient site. Fat grafting may improve contour after lumpectomy or reconstruction; it is not suitable for everyone and may require more than one procedure.

Autologous fat grafting uses fat from a donor area such as the abdomen, flanks, thighs, buttocks or back. The donor site is chosen with body shape, localized fat, scars, trauma and prior surgery in mind. Scars are concealed as much as possible, often in a fold or near the navel. The abdomen may not be first choice because irregularities and perforator injury are concerns. In selected patients with breast cancer-related lymphedema, the lymphedematous arm has been described as a donor site. Several sessions may be needed, especially after radiation, and fat survival depends on recipient-site vascularity. This remains an individualized surgical decision.

Successful fat grafting depends on recipient-site compliance and capacity, plus careful harvesting, processing and delivery. Without adequate pre-expansion, grafting may be limited to small volumes, around 100 cc or less, that do not exceed high interstitial pressure; larger planned volumes may not be safely placed. Some patients have too little donor fat, and weight gain is feasible only if they can maintain it. Because some grafted fat resorbs, several sessions may be needed, especially after radiation. Weight changes and scar tissue can also influence measured breast volume change. Fat necrosis can appear as small palpable nodules, usually benign, but should be discussed with the provider.