It is thanks to the Italian School that lipofilling is now used in reconstructive breast surgery. In this case the focus is not the cosmetic augmentation of healthy breasts (with or without implants), but the reconstruction of the breast after mastectomy, or to treat defects or asymmetry resulting from radiotherapy. Nowadays lipofilling is considered a consolidated technique in reconstructive breast surgery, and has been validated by numerous publications in major international scientific journals.

The operation

Lipofilling is a surgical technique that consists of three main phases: harvesting fat, its purification via centrifugation or another suitable method, and its injection into the area to be treated. The sites most often used to harvest the fat are the lower abdomen, flanks (“love handles”), thighs, and the inner side of the knee. First an anaesthetic and vasoconstrictor solution is injected into the donor site (wet technique), and then the adipose tissue is harvested through small incisions using suitable aspiration cannulas. The fatty tissue is then processed, and subsequently injected in small quantities so that it survives uniformly and stably. Only small quantities of fat are injected to promote integration with the surrounding tissues of the recipient site, and for the same reason it is preferable to inject the adipose tissue into different layers at different levels (multiple deposition planes using the same infiltration cannula) and over a wide area. This will improve survival and the generation of new blood supply to the grafted tissue, thereby allowing it to “settle in” correctly. In other words, the fat is injected through a small-bore needle connected to a syringe in very small quantities, and into many different channels at several different levels, to create a three-dimensional network of transplanted fat, which promotes both revascularization (the development of new blood vessels) and long-term stability.

The potential of this treatment has recently been further enhanced by technological advances such as water-assisted harvesting systems like the Body Jet, as well as stem cell enrichment systems like the Celution System.

Indications:

Correcting complications of breast implant surgery: Lipofilling is particularly useful in implant surgery, and can be performed during the various phases of reconstruction to increase the thickness of the tissue under the skin and over the implant. In this way it can reduce the risk of skin rippling and implant exposure, as well as the risk of capsular contracture syndrome. The use of fat grafts is especially indicated when the tissues overlying the implant are thin, for example in cases where a breast tissue expander has been used, radiotherapy damage is an issue, or where the patient cannot be offered autologous reconstruction.

In implant surgery, complications affecting the soft tissues that cover the implant may leave visible irregularities in the surface layers of the breast. In such cases, and if visible wrinkling of the silicon implant walls occurs, fat can be harvested and injected into regions around the breast to thicken the tissues covering the implant and correct its unsightly appearance. In other cases, specifically those patients with scarce fatty tissue under the skin and limited muscle trophism (blood supply), the upper part of the implant may become visible and give the breast an artificial look. In these patients, the breast can be made to look more natural by transplanting adipose tissue around the entire border of the implant.

Post-mastectomy patients can also benefit from fat grafts, with or without stem cell enrichment. These can be used in association with implant surgery, but it is also possible to perform breast reconstruction using fat grafting alone. This type of lipofilling requires several treatments, and can be facilitated by means of a suction-based breast enlargement device that creates negative external pressure (the Brava System), or different harvesting and/or stem cell enrichment techniques.

Capsular contracture syndrome: This is, without doubt, the complication that causes the greatest morbidity in patients who undergo breast reconstruction via implant surgery. Implants invariably become surrounded by a layer of scar tissue (capsule), which, in the majority of cases, remains soft and pliable, and therefore has little effect on either the shape or the consistency of the breast. However, in a significant percentage of patients, the capsule can gradually increase in thickness and shrink. This is called capsular contracture, and causes deformation of the implant, compressing it into an unnaturally rigid spherical shape. Although slight capsular contracture usually requires no treatment, in more severe cases (grades III and IV), lipofilling can be used to correct the deformities in the shape and position, as well as, in certain cases, reduce the severity of the capsular contracture.

 

After breast-conserving surgery: Breast-conserving surgery can damage the breast skin and underlying tissue (parenchyma), leading to unsightly deformities, which may also affect the areola and nipple, usually by changing their shape or position. Nevertheless, excellent results have been reported when lipofilling has been used to correct such deformities in patients who experience breast volume reduction and/or distortion following QUART (surgery plus radiotherapy). Many QUART patients feels that it is prudent to wait for at least 1 to 2 years after the procedure, although many Centres will provide lipofilling even before this settling period has elapsed.

 

Scarring: Lipofilling may also be successfully used to correct and improve the appearance of scarring. In these cases the injection of adipose tissue under the skin can improve the tissues, filling dents and hollows, and smoothing out irregularities. This occurs thanks to the combined action of fat as a joint “filler” and local source of stem cells and growth factors. Fat grafting is performed to correct deficits in the layers beneath the skin, and improves both the quantity and the quality of the superficial component of the dermis.

Coleman SR, Saboeiro AP. Fat grafting to the breast revisited;safety  and efficacy. Plast Reconstr Surg. 2007 Mar; 119 (3):775-85

Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant:a healing process mediated byy adipose-derived adult stem cells. Plast Reconstr Surg. 2007 Apr 15; 119(5): 1409-22

FAQs:

What kind of anaesthesia is used?

Local anaesthesia + sedation, or general anaesthetic

How long will I have to stay in hospital?

1 day or day-hospital

When can I resume my normal social activities?

After 1 week