Objective
Dr. Nicolaidis was fortunate enough to hear the first formal presentation on fat transfer to the face by Sidney Coleman in 2000, when he was still working in New York. Fat is removed from the patient using liposuction, then concentrated and re-introduced in any area of the body desired. In order for the fat to survive, it has to be injected in small quantities and fine lines, surrounded by the patient’s tissues which will vascularize the fat. In the years following Dr. Coleman’s presentation, progressively larger quantities of fat were transferred to other parts of the body, notably the breasts and buttocks. As larger quantities are injected in an area, more fat loses direct contact with the patients’ tissues, leading to resorption rates around 50% (meaning that 50 % of the transferred fat will disappear over time). If too much fat is transferred, cysts may form which can be misinterpreted on mammograms as possible breast cancer. A work-up then becomes necessary to eliminate possible breast cancer, yet another unpleasant experience for patients who have already suffered enough.
The obvious patients who benefit the most from fat transfer to the breasts are those had no or minimal breast tissue to begin with. Now try to imagine transferring fat in that patient’s very limited breast tissue right after explantation, when there is a large empty pocket following explantation. Keep in mind that a surgeon cannot control exactly where the transferred fat goes; rather, fat will go wherever there is space. If the fat enters that empty pocket, the fat will completely die and may lead to an infection as well. For these reasons, Dr. Nicolaidis will perform LIMITED fat transfer to the breast at the time of explantation in a very particular set of explant patients. His focus initially is to minimize the folds using various breast lift techniques, which he will discuss with patients at the time of consult. Fat transfer is then used as a secondary procedure 3-6 months later in order to correct any resulting irregularities or asymmetries after explantation. The other advantage of doing DELAYED fat transfer (rather than at the time of explantation) is that MORE fat can be transfered to the breast since the explant space is closed and there are no incisions through which the fat will escape.
Anesthesia For Fat Transfer to the Breasts
Most cases require general anesthesia for maximum patient safety and comfort as well as more aggressive fat removal.
Surgical Techniques
Fat is removed from unwanted areas using various liposuction techniques. However, rather than throw out this fat, the fat is concentrated through numerous means and reinjected in areas of the breasts lacking fullness, typically the upper aspect of the breasts. Care must be taken in order to avoid excessive injections in any given areas in order to avoid fat cell necrosis (or death), leading to more fat resorption, or cyst formation.
Recovery after Fat Transfer to the Breasts
Patients are generally asked to wear a compression garment for one month after surgery in the liposuctioned areas. On the other hand, we try to avoid pressure on the breasts.
Return to Work after Fat Transfer to the Breasts
Patients can usually return to work in just a few days, though swelling and bruising usually take several weeks to subside.
Possible complications
The most common problem after liposuction involves irregularities of the skin surface, including depression or wrinkling. As already mentioned, up to 50% of the transferred fat can be resorbed (or disappear). Fat transfer risks include cyst formation, infection and microcalcification.
Post-op Instructions after Fat Transfer to the Breasts
In the first week after fat injection, be sure to :
- Keep your dressings dry and clean ;
- Wash with a sponge unless Dr. Nicolaidis says otherwise ;
- Avoid pressure over the area of fat injection ;
- Wear your compressive garments (if provided) at all times for the areas liposuctioned ;
- Walk at least 5 minutes every hour during the day (do NOT simply stay in bed constantly).
Your first post-operative appointment for fat injection with Dr. Nicolaidis is very important, even if you feel very well.
After the first week of fat injection:
- Patients may shower;
- Continue to avoid pressure over the area of fat injection for at least 2 more weeks ;
- Protect your new scars from sun exposure for a total of 6 months ;
- Continue wearing compressive garments (if provided) until Dr. Nicolaidis says otherwise ;
- In order to avoid blood clot complications, keep moving (walk regularly during the day).
Please note :
- It is normal to have some bruising in the area of fat injection in the first weeks after surgery.
- For your comfort, be sure to take your pain medication as prescribed.
* Does not constitute a guarantee of results