Orlando Breast Surgery Blog

Providing the Best in Natural Breast Reconstruction to Orlando & nearby areas of Florida

New Study Supports Fat Grafting Safety

Thu, 04/23/2015

In a United States multicenter  study  presented at the annual meeting of the American Association of Plastic Surgeons, fat grafting was demonstrated to be a safe procedure after breast cancer surgery.

Specifically the incidence of breast cancer recurrence was studied in patients who received fat transfer as part of their breast reconstruction, and confirms the findings of previous studies performed in European studies demonstrating no increased breast cancer recurrence in patients receiving autologous fat transfer (fat grafting).

The study included patients from Washington University, St. Louis; Memorial Sloan Kettering, New York; MD Anderson Cancer Center, Houston; University of Chicago, and the University of North Carolina.

Increasingly, fat transfer is proving to be a safe, low impact option for women seeking breast reconstruction after cancer

Fat Transfer Concepts and Patience

Thu, 10/30/2014

During consultations with patients about fat transfer, I spend much of my time explaining the concepts of fat grafting, how it works, dispelling myths, and setting expectations. 

Fat transfer or fat grafting, is a process known in surgical terms as a free graft. This means that the fat that is transferred from any part of the body to the breast or elsewhere is not transferred with it's own blood supply, so must acquire blood supply and nourishment from the tissues into which the graft is placed. This is as opposed to grafts like tissue flaps which are moved from one part of the body and their man blood suppy is maintained by a major blood vessel that is moved with the flap. This free graft concept is at the core of both the advantages and disadvantages of fat grafting. Unlike a flap which is never truly a part of the surrounding tissues, a free fat graft actually becomes integrated into, and a part of the tissues into which it is placed. This is the reason that we see some of the amazing benefits of fat transfer such as healing of radiation damaged tissue, restoration of sensation with nerve ingrowth and other true regenerative processes associated with fat transfer. Because fat transfer is a free grafting process, this also limits the amount of fat that can be transferred by injection into the tissues at any one time. This is why fat transfer, particularly for breast reconstruction is often a staged process. Every time a fat transfer process is performed, some fat survives and some fat does not survive and is absorbed. Depending on a number of factors, including technique, the individual patient, the quality of the area to be grafted, and devices like BRAVA being used, fat survival will vary from 35-80%. This does not mean that fat transfer does not work as some have stated, it simply means that fat transfer may require more than one procedure to achieve the desired result. Each procedure will build upon, and add to the previous one, until the final result is achieved.

Patients who choose fat transfer must be prepared to accept this concept. Breast reconstruction patients in particular, must be patient if this is the procedure they choose. On the positive side, each fat transfer is nothing more than a liposuction procedure, followed by reinjection of the grafted fat. These are procedures that have an extremely low risk of complications and have a rapid recovery, when compared to other breast reconstruction procedures.

One of the most important requirements that I impress on my patients, is that patience is required. Anyone who is unwilling to accept that fat transfer is a process that may require stagedd procedures and take some time, is not a good candidate for the procedure. In order to make it easier for patients, we offer fat banking in our Liquid Gold Lipobank® for suitable patients, so that only one liposuction procedure may be required.

Lipoflap procedure poster presentation at ISPRES 2014

Sun, 09/14/2014

I have just returned from the 3rd Annual Meeting of the International Society of Plastic Regenerative Surgery, where I presented my poster on the Lipoflap Procedure to enhance breast  reconstruction with implants. The meeting was attended by attendees from 37 countries. The applications of fat transfer for breast reconstruction continue to expand, as well as other applications such as scleroderma, non-healing wounds, facial anti-aging and rejuvenation. 

The lipoflap procedure, using autologous fat transfer to thicken and improve the tissue covering breast implants, particularly after breast reconstruction, is the most frequent breast reconstruction procedure I perform. Many breast cancer survivors who have had breast reconstruction with implants are unhappy with the look and feel of their breasts. This is primarily due to insufficient tissue coverage over their implants. 

Treating Radiation Pain and Breast Deformity and Complications with Fat Transfer

Sun, 04/06/2014

 

Radiation is a standard part of the prescribed treatment for many women diagnosed with breast cancer. Radiation is frequently combined with partial mastectomy or lumpectomy, Orin combination with chemotherapy after mastectomy. Of course the benefit of radiation therapy is to reduce the risk of recurrence of breast cancer. Unfortunately, radiation therapy is almost always associated with damage to the remaining tissue. Sometimes this damage is minimal, but frequently it may result in severe scarring and deformity, and even pain. In severe cases, there may even be tissue breakdown and then failure to heal. Unfortunately these problems may be progressive and get worse over time rather than better. Lumpectomy with radiation is often called 'breast sparing' surgery, but in many cases the result is a severely deformed deformed breast completely different in shape and size to the other breast. Radiation over breast implants or tissue ex panders used in breast reconstruction is also associated with a very high complication rate. Complications include severe hardening, misshapen breasts, and even implant extrusion.

Autologous fat transfer (AFT) is now considered the method of choice for treating radiation damaged tissues, and gives hope to women suffering from complications from radiation therapy. In the past there were really no options to treat radiation damaged tissue. Additionally, fat transfer requires no additional scarring as it involves only liposuction and careful injection of the fat into the damaged tissue. As with any technique, skill and experience are required to ensure the best results with low risk of complications.

For those women who experience pain after radiation therapy, or even reduced mobility of the arm, one of the first benefits they experience is reduction or elimination of their pain. With repeated AFT procedures increased softening of the tissues and mobility can be expected.

AFT effectively transforms scarred, rigid tissue, to soft pliable tissue, a true regeneration effect of fat transfer. 

No BRAVA® no Breast

Sun, 03/09/2014

The success of breast reconstruction and augmentation with fat transfer is dependant on two factors, meticulous technique and maximum tissue expansion with the BRAVA® external tissue expander. These two factors are once again emphasized in another paper published in the March edition of the prestigous journal, Plastic and Reconstructive Surgery. The aricle is titled 'Megavolume Autologous Fat Transfer; Theory and Principles' by Dr's Khouri, Rigotti and others.

The first component of fat grafting or fat transfer is meticulous technique using the correct instrumentation and skilled layering of the fat in delicate ribbons spaced throughout the areas of the breast being grafted. The second component, in order to maximize the amount of 'space' and blood supply available for the grafted fat is to make sure that the maximum possible amount of expansion is achieved with the BRAVA® device prior to the fat transfer procedure. In more than 1000 cases Dr. Khouri has shown that the amount of fat that can be transferred can be more than doubled by following these principals.

Of course the actual grafting procedure is dependant on the skill of the surgeon, but the use of the BRAVA® is dependant on the dedication of the patient, but  the more dedicated the patient is to maximizing the effect of the BRAVA® device by wearing the device diligently and continuosly, the more fat can be transferred at a single procedure, and the higher the percentage survival of that fat. 

 

Traditional Breast Reconstruction techniques have high complication rate

Sun, 03/09/2014

In yet another paper published in the Annals of Surgical Oncology, traditional breast reconstruction techniques using breast implants and expanders and/or tissue flaps such as the  microsurgical abdominal flaps, a high rate of complications is documented. In 254 cases documented, complications with tissue flaps exceeded 21%, and with implants and expanders the complications exceeded 37%. Furthermore hospital stays were between 2- 4 days for these procedures. (Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: A critical study of 254 cases 
Annals of Surgical Oncology, 02/24/2014  Review Article Liu C, et al.)

In contrast we have found breast reconstruction with fat transfer to have a mnior complication rate of less than 5%, and a 0% major complication rate. Minor complications have included fat necrosis or loss of small amounts of fat, and some skin irritation with the use of the BRAVA® tissue expansion device.

Furthermore, breast reconstruction with fat transfer is a 100% outpatient procedure, without the need for hospitalization. Almost half of our patients who request fat transfer for breast reconstruction, have had complications with other methods of breast reconstruction.

The Increasing Utility of the Lipoflap Fat Transfer Procedure (LAFT) in Breast Reconstruction

Sun, 01/26/2014

Increasingly I am utilizing the Lipoflap Autologous Fat Transfer procedure to help patients with unsatisfactory breast reconstruction results after breast cancer reconstruction. The most frequent use of this procedure is to improve or salvage the outcome after breast implant and expander reconstruction procedures. In the United States, the most common method of breast reconstruction after mastectomy is the placement of a tissue expander, with subsequent expansion, and then final implant placement.  Less frequently this procedure may be combined with a latissimus dorsi muscle flap procedure to provide better tissue coverage over the expander and implant.

Even in the best of circumstances, expander placement and expansion results in thinning of the skin over the expander as the expander is inflated, just as the skin of a ballon gets thinner as a balloon is blown up. When the final implant is placed

 

The increasing utility of the Lipoflap Fat Transfer Procedure (LAFT) in Breast Reconstruction

Sun, 01/26/2014

Increasingly I am using the Lipoflap Autologous Fat Transfer (LAFT) procedure to help patients with unsatisfactory breast reconstruction results after breast cancer reconstruction. The most frequent use of this procedure is to improve or salvage the outcome after breast implant and expander reconstruction procedures. In the United States, the most common method of breast reconstruction after mastectomy is the placement of a tissue expander, with subsequent expansion, and then final implant placement.  Less frequently this procedure may be combined with a latissimus dorsi muscle flap procedure to provide better tissue coverage over the expander and implant.

Even in the best of circumstances, expander placement and expansion results in thinning of the skin over the expander as the expander is inflated, just as the skin of a ballon gets thinner as a balloon is blown up. When the final implant is placed, the result is an implant that is only covered by a thin layer of skin. In almost every case, one can feel the implant easily under the skin. Other problems that occur with varying frequency are uneven implant position, obliteration of the space between the breasts, rippling, capsular contracture or hardening, uncomfortable temperature changes of the breast area, and pain. In most cases there is also little or no sensation of the overlying skin. When radiation therapy is added to the situation, the incidence of these problems skyrockets. It is my impression, that the incidence of at least some capsular contracture or hardening for patients with implants who have had radiation therapy, is close to 100%.

The concept of the LAFT procedure is to use fat transfer to thicken and improve the quality of the tissue and skin overlying breast implants. This process can be used in almost every situation where there is insufficient skin thickness and / or poor skin and tissue quality. Fat transfer is performed using established micrografting techniques, placing the fat into the tissue overlying the implant, increasing tissue thickness and restoring tissue quality. The process can be repeated until the tissues are adequately restored, or continued until the breast has been completely restored with fat and the implants can be downsized or removed.

Advantages of the LAFT procedure include:

  • Immediate improvement in the natural look and feel of the breasts
  • Correction of capsular contracture (hardening) and implant malposition
  • Improvement and resolution of pain and discomfort of the breasts
  • The ability to remove the implants altogether if desired
  • Restoration of sensation to the overlying skin

The LAFT procedure can be used as the main procedure for breast reconstruction, prior to placing an expander or implant. The benefit of the LAFT procedure prior to placing an expander or implant, is that the final reconstruction will provide much better tissue thickness and quality over the implant.

Of course all the benefits of scarless procedures using only small needle fat micrografting procedures apply to the LAFT procedure. The LAFT procedure can even be used to improve the results of cosmetic breast implant procedures, in cases of capsular contracture, implant rippling, or to improve breast shape and cleavage.

For more information about the Lipoflap Autologous Fat Transfer (LAFT) procedure, contact us at the Breast Center at the Bougainvillea Clinique

 

Treating Radiation Pain with Fat Transfer

Sun, 12/29/2013

Radiation is a standard part of the prescribed treatment for many women diagnosed with breast cancer. Radiation is frequently combined with partial mastectomy or lumpectomy, Orin combination with chemotherapy after mastectomy. Of course the benefit of radiation therapy is to reduce the risk of recurrence of breast cancer. Unfortunately, radiation therapy is almost always associated with damage to the remaining tissue. Sometimes this damage is minimal, but frequently it may result in severe scarring and deformity, and even pain.  In severe cases, there may even be tissue breakdown and then failure to heal. Unfortunately these problems may be progressive and get worse over time rather than better. Lumpectomy with radiation is often called 'breast sparing' surgery, but in many cases the result is a severely deformed deformed, and sometimes painful breast, which is completely different in shape and size to the other breast. Radiation over breast implants or tissue ex panders used in breast reconstruction is also associated with a very high complication rate. Complications include severe hardening, misshapen breasts, and even implant extrusion and pain.

Autologous fat transfer (AFT) is now considered the method of choice for treating radiation damaged tissues, and gives hope to women suffering from complications from radiation therapy. In the past there were really no options to treat radiation damaged tissue. Additionally, fat transfer requires no additional scarring as it involves only liposuction and careful injection of the fat into the damaged tissue. As with any technique, skill and experience are required to ensure the best results with low risk of complications.

Until recently there have also been no treatment options for women with pain after radiation therapy. Autologous fat transfer provides new hope for these women. One of the first things we have observed when performing AFT on women suffering from radiation related pain and tissue problems is the improvement in their pain. Often there pain is completely resolved with just one fat transfer procedure, before actual improvement in the tissue itself is observed.With repeated AFT procedures we routinely see improvement in the quality and mobility of the tissues

AFT effectively transforms scarred, rigid tissue, to soft pliable tissue, a true regeneration effect of fat transfer. For more information regarding treatment of radiation related pain and other complications of radiation therapy for breast cancer and cancers in general, contact us at the Breast Center at the Bougainvillea Clinique.

Fat Transfer increasingly the option of choice in breast procedures

Sun, 11/24/2013

This weekend I attended the 11 the annual meeting of IFATS in NYC, where scientists and surgeons from around the world got together to talk about the latest in fat transfer and fat stem cell technologies in the laboratory and in patient care. In addition to all the excellent advances in facial rejuvenation using nanofat technology, there were numerous presentations showing how fat is increasingly becoming an accepted part of the treatment and even the treatment of choice in breast reconstruction and augmentation. There were numerous presentations demonstrating the use of fat alone, fat with implants, and even fat with tissue flap procedures. Many of those attending agreed that fat transfer is now the gold standard in the treatment of radiation complications, to the extent that we can now even recommend fat transfer to prevent radiation treatment related complications such as capsular contracture of implants and tissue breakdown.

I had the opportunity to present my talk on standardization of fat transfer techniques for more consistant results and better comparisons of existing techniques.

For more information about autologous fat transfer to the breast, call or email us today.

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Winter Park, FL 32792
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