Posted in: Breast Cancer Blog , Thursday September 30, 2021

Video Transcription

I am Dr. Frederick Lukash. I’m a board certified plastic surgeon. I’ve been in practice for over 40 years. I do the full spectrum of plastic surgery, including breast reconstruction, which I’ve been doing for the full length of my career going through all the different iterations in techniques. In point of fact, my interest in breast reconstruction goes back to the early ’80s when I was involved in an organization that ultimately became the Race for the Cure, and was involved in bringing it from Texas to New York.

Fat transfer in breasts has recently become very popular. It is a method of taking tissue from one area of the body, and free transferring it into the breasts. There are some surgeons like myself who will attempt to reconstruct an entire breast with fat, and there are other surgeons who will use it as an augmented technique to refine a flap that they’ve done, or to blunt and shape tissues after implant reconstruction.

Fat grafting is done by essentially liposucing the fat. I particularly do it by hand under a low pressure, so that the fat cells are not violated. And then that fat gets transferred into the patient. And there are various ways of doing it to ensure the viability of the fat. Fat grafting works like any other graft. It’s living tissue. When it comes out of the body, it’s not living tissue. And when it gets put back in, it has to pick up a blood supply. Therefore, the technique has to be a very refined technique where the fat goes in as small little spaghetti strand, so that it can pick up a blood supply around the tissue that you’re grafting into. Otherwise, it won’t survive. If you put it in as a blob, like a lake, the periphery will pick up a blood supply. The central portion will not, so you’ll lose the amount of fat.

The percent of fat depends upon how much you put in. If you get exuberant and you put in too much, you’re going to lose a lot of it. Because it’s like going up the rollercoaster. You’re adding, adding, adding. You add too much, you go down the other side and you lose it. Therefore, if you’re building a breast, you can perhaps put in 150 grams of breast tissue. Then you have to start, wait three months, let it pick up a blood supply, and do it again. Now, I use a technique that not many people use called BRAVA. It’s a basically a suction cup on the breast, and you do it for period of time. And what it does is it increases the size temporarily, and it increases the circulation. So, it allows you to put more fat in.

The average success rate through national averages is 50%. With BRAVA, you can get about +80%. Ultimately, you can get many cup sizes, but you can’t do it all in one setting. You can usually go up half a cup to a cup in one setting. But if you’re building a breast in breast reconstruction … like I would try to do from nothing, and you’re trying to go from nothing to a C cup, you’re not going to do that in one setting. If the fat that you graft picks up a blood supply, it lasts as long as you last. And the advantage to fat grafting is it will gain weight when you gain weight, and it will lose weight when you lose weight. Because it’s just part of your body, so it gets incorporated and it’s your living tissue.

The risks for fat grafting are no different than the risks for other surgical procedures like anesthesia and your own general health. But the ability to make it a favorable procedure is that there are no big incisions. It’s out-patient. There are no big recoveries. There are no drains. There are no stitches to be removed. It’s just all … and it’s a two-for-one. Because in many ways, you can reshape the body to build the breast. You can get fat out of the belly. You can get out of the love handles. You can get out of the thighs in order to build what you want. It’s a bonus.

Recovery for fat grafting is essentially no different than recovery from liposuction. People go into a garment. Within a few days, they’re just wearing Spanx. The breast heals well. We don’t like pressure on the breast in a bra for a few weeks. But after that, people are doing whatever they want to do within a matter of days. Now, obviously, if you have no fat, you can’t have fat grafting. Some options define themselves. If you have no body fat, you’re an implant reconstruction. If you have only a little abdominal area, you may become a flap reconstruction there, or you may be the back flap. But if you have donor tissues and you want to go the route, it’s not a one and done, but it’s an out-patient, minimal risk procedure. And there are surgeons around the country, myself included, who will undertake that process if the patient’s willing to do it.