Fat transfer may offer another option for breast reconstruction
A Dutch study found rebuilding the breast only with a patient’s own fat had high satisfaction, low complications

Dutch plastic surgeons are further developing a new option for breast reconstruction after mastectomy using only a patient's own fat to rebuild the breast. The technique, known as autologous fat transfer, may be suitable for patients who don't want implants or aren't good candidates for flap reconstruction, according to a new study in the October issue of Plastic and Reconstructive Surgery.

"There are still going to be patients that are going to go for the implant," said the study's lead author Andrzej A. Piatkowski de Grzymala, MD, PhD, a professor at Maastricht University Hospital. "There are still going to be patients wanting flap surgery, and there are going to be patients going for the autologous fat transfer. I think that is a good coexistence because there's no perfect reconstruction for patients."

An additional breast reconstruction option

Autologous fat transfer offers an option for patients who are not candidates for other breast reconstruction methods, such as implants or who do not have enough tissue and fat for flap reconstruction.

Dr. Piatkowski has researched this technique for a decade. The study showed it is a safe, effective option with few complications and a high patient satisfaction rate. This option is now available to women in the Netherlands and covered by the country's health insurance system.

How it works

The procedure happens in stages. After mastectomy, patients wear the EVE-bra to expand the skin on their chest. Then they receive liposuction on several sites across their body, including the belly, back, hips and thighs, to collect fat. That fat is processed and then injected into their chest to rebuild the breast.

Each surgery is outpatient and takes about an hour. This process is repeated about every three months for around a year. Typically, patients need about four procedures to reach their reconstruction goals.

A more natural look and feel with less scarring

One advantage is that a breast rebuilt with autologous fat transfer looks and feels natural, and ages like one.

"It feels warm," said Dr. Piatkowski. "What is even more interesting is breast sensation comes back over time, and you will never achieve this with an implant."

He noted that sensation does not fully return, and it's not yet understood why some sensation is restored.

This treatment also leaves significantly less visible scarring than other breast reconstruction techniques because it doesn't use long incisions.

"We only use needle pricks," said Dr. Piatkowski. "Scarring is nearly non-existent."

He pointed out that scarring varies from patient to patient, as some people are more prone to raised or thick scars.

Real results

The study showed that after a year of treatment, most patients experienced significant improvements in quality of life, including satisfaction with their breasts, physical well-being and with the outcome. Plus, patients were satisfied with the results of not only their breasts but also their bodies, including the abdomen, back, hips and thighs because the liposuction offered the additional benefit of body contouring.

"We saw people really liked the body improvement that they got from it," said Dr. Piatkowski.

The study concluded the treatment was a safe and effective option for breast reconstruction with a low complication rate.

Trade-offs

Yet, some patients found the treatment demanding. The study described the process as intense and burdensome because it requires multiple procedures needed over a long period of time.

"What we hear from patients is that it's a long journey," said Dr. Piatkowski. "But when we ask our patients after treatment is complete, they're very, very happy and they're very positive about their results. The results of quality of life over the long term are very, very positive."

Dr. Piatkowski pointed out most breast reconstruction techniques are staged procedures and often require about a year to fully complete.

"When we talk to our patients, we always say it's not going to be one surgery," he said. "The time to completion for autologous fat transfer is not a big difference from implants or flaps. It's a bit longer, that's what we say, but not such a big difference."

No revisions are typically required once treatment is completed. Dr. Piatkowski explained that while some breast fat is lost during treatment, the final results after the last procedure are permanent, and breast size doesn't change significantly afterward. The procedure is generally used to reconstruct the breast up to a C cup in the Netherlands, though larger sizes are sometimes possible.

The most challenging aspect of the procedure for most patients is the EVE-bra device that is used to stretch the skin on the chest.

"That's the biggest issue, actually," said Dr. Piatkowski. "It creates a lot of skin irritation. This really has the biggest impact on their life."

Newer versions of the devices are less irritating and may offer a better patient experience in the future.

Next steps

Dr. Piatkowski has already begun another study to learn if this reconstruction technique works for patients who received radiation as part of their breast cancer treatment. Additionally, the team is looking for ways to improve the patient experience, reduce the number of procedures needed and possibly make the treatment available to more patients with less fat.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.