Fat grafting in reconstruction

Your own fat, at every stage of reconstruction

Breast reconstruction after mastectomy very often benefits from lipomodelling and fat grafting. Here, fat is not an alternative to the implant: it prepares its place, then corrects its shortcomings.

Dr Azencot began using fat to improve flap reconstructions as early as 2003, then to use it before implant reconstruction to add volume and improve tissue quality: that is primary lipomodelling.

Primary lipomodelling, before the implant

It consists of one session of autologous fat injection into the chest to be rebuilt. Generally 150 to 250 cc are injected; the donor site is always available.

What this stage prepares

It prepares the future implant pocket in three ways: by increasing the thickness of the soft tissues around the implant and at the cleavage; by mechanically releasing the skin and the fibrosis, through the passage of microcannulas and the percutaneous trocar technique, or fasciotomies; and by bringing biological elements that soften the pocket and improve local tissue quality, especially after radiotherapy.

The operation and recovery

The operation lasts one hour under general anaesthesia, with an overnight stay. Recovery is very undemanding, apart from pain at the donor sites.

The main complication is liquefaction of part of the grafted fat, requiring aspiration at the office. Grafted fat is stable after three months: placement of the reconstruction implant is then scheduled.

Secondary lipomodelling, after the implant

This procedure reinforces the effect of the grafted tissue from three months after implant reconstruction. It is offered according to your own case.

Known as secondary peri-prosthetic lipomodelling, it is effective in improving the natural feel, the softness, the concealment of the implant, and the harmony of the cleavage.

The technique is the same as for primary lipomodelling; the quantity injected is often larger, generally between 200 and 400 cc. These sessions bring the result close to that of autologous flaps.

As a complement to a flap

Where autologous flaps have been used for reconstruction — latissimus dorsi without a prosthesis, or rectus abdominis — fat grafting supplies the complementary volume and improves the shaping of the flap.

Reconstructions using a latissimus dorsi flap without a prosthesis are thus completed in volume by fat grafting, the flap volume alone often being insufficient when an implant is to be avoided. Reconstructions using a rectus abdominis flap can likewise be completed in volume and improved in their contours.

Exclusively autologous reconstruction

It consists of rebuilding the shape and volume of the breast through several sessions of fat grafting, with neither implant nor flap.

The chances of success depend on the flexibility of the skin and the quality of the recipient site. Most of the time these are irradiated chests.

While the technique remains possible, it stays difficult to promise a sufficient result and volume. Caution and reserve are therefore called for, particularly for medium and large breasts, cup sizes C and D.

External expansion

Continuous external expansion, known as BRAVA, is then particularly indicated to increase the fat take rate and reduce the number of sessions.

The practitioner nevertheless remains attached to the sequence of primary lipomodelling, then implant placement, then secondary lipomodelling, which he considers reliable and reproducible.