Innovation in breast reconstruction

Posted on 9 May 2017

An innovative method of using the patient’s own fat in breast augmentation and reconstruction after mastectomy has many benefits and few drawbacks, says a Mediclinic plastic surgeon.

‘Fat-grafting’ is a safe and effective procedure in which fat is removed by liposuction from one part of the patient’s body and injected into her breasts. ‘It’s almost like sowing seeds in fertile soil,’ says Dr Christiaan Gildenhuys, a plastic and reconstructive surgeon at Mediclinic Panorama, explaining the principle behind the technique. ‘If you surround a piece of tissue with enough healthy tissue, that tissue will start growing.’

How does fat-grafting work?

Pioneered by American plastic surgeon Dr Roger Khouri, fat-grafting involves, first, simple liposuction, with the fat to be used in the breast-augmentation procedure being harvested from the patient’s own body. ‘We process the fat, getting rid of the stuff we don’t want, so we end up with a concentration of fatty tissue,’ explains Dr Gildenhuys.

Using a tiny (1mm) needle, the surgeon finely disperses the minuscule (1x1mm) chunks of fat between the healthy breast tissue. ‘The way the surgeon distributes the fat determines the shape of the breast,’ says Dr Gildenhuys, describing this part of the procedure as being like airbrushing. ‘A normal breast isn’t perfectly round – it’s almost teardrop-shaped going into the armpit, and that shape can be achieved quite nicely with careful placements of the fat injections.’

Patients with an average breast size are the best candidates for this procedure, as the volume of breast tissue a patient has determines how much fat can be injected. ‘With patients who have no volume at all, it would require an initial session of grafting to create tissue to graft into, effectively building a foundation to build on,’ explains Dr Gildenhuys. ‘You have to get a good ratio between the cells that are there and the injected cells, and every injection must be surrounded by healthy breast tissue.’

What are the benefits of fat-grafting?

‘Because we use such a small needle, it’s near scarless surgery,’ says Dr Gildenhuys. ‘And, of course, we don’t need to make any incisions. It’s a matter of a few small puncture wounds, both for the harvesting of the fat and for the fat injections.’

Fat-grafting also yields a more natural breast shape. ‘Prosthesis concentrates on the centre part of the breasts, where the cleavage is, and this often results in a less natural shape on the outer sides of the breast,’ Dr Gildenhuys explains. The fat-grafting technique, with its careful placement of the fat injections, usually results in a more natural shape.

The fact that there’s no prosthesis used ticks several boxes: ‘You save on the cost of the prosthesis; you don’t end up with a foreign object in your body; and because the process uses your own tissue, you end up with warm, healthy tissue rather than the coldness of a breast implant.’

Also, there aren’t the complications associated with an implant, such as capsular contracture (when scar tissue forms a tight casing around the implant, contracting it until it becomes misshapen and hard), infection, and poor ageing as the breast ages, with the effect of gravity over time causing the implant to become more visible.

And last but not least: ‘To a certain extent, you get a little bit of bonus liposuction included in the package,’ says Dr Gildenhuys. This is because the surgeon gets input from the patient on where on her body she wants the fat to be harvested from. ‘It’s usually the fatty area below the umbilicus on the lower belly, but many women struggle to shed fat from their hips or inner thighs, and we can harvest the fat from those areas.’

What are the drawbacks?

‘In an era of instant gratification, the technique takes some time to show results. If a woman opts for implants, she’s in theatre for 40 minutes and she emerges with a result. With fat-grafting, it takes a couple of days for the swelling to subside and a few weeks for the fat globules to settle in,’ says Dr Gildenhuys, who adds that 70 to 80% of the fat ‘takes’ and grows. ‘Within two to three weeks the patient will have a very good idea of the final result.’

If the patient isn’t entirely happy, there’s always the option of returning for further fat injections at a later stage.

Published in Cancer

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