FAT GRAFTING
REMOVING FAT FROM THE BELLY AREA
As part of the harvesting of fat, Dr. Joshua Lampert offered her the possibility to undergo abdominal etching, which is the removal of fat deposits from the belly area, followed by the shaping of the abdominal wall to create a sixpack look. A two-for-one cosmetic effort, if you will.
The abdominal etching, Lampert says, is actually “a relatively simple procedure. It provides an enhancement, especially since we’re already working in the area.”
Like Lampert, most plastic surgeons use fat grafting as a secondary type of reconstruction procedure, to smooth imperfections from implants. One Miami doctor, however, has mastered the process of using fat grafts for a complete breast reconstruction.
Dr. Roger K. Khouri says his patients, many of whom are nurses and physicians, are unhappy with their implants. “They complain that their breasts are cold, numb and rock hard,” he says. “They don’t look natural.”
Khouri does not leave the implants under the skin. Instead, he gradually “subtracts” volume from the implant while adding harvested fat to make up the difference. By the end, there is no implant but the patient is left with a complete breast built from her own tissues. This requires two or three sessions.
“This is not for the woman who wanted it yesterday,” Khouri says. “But in the end, they’re very happy with the results.”
Many of his patients travel from out of state. One of them is Idaho nurse Joanna Townsend, who was diagnosed with cancer three years ago. She was never comfortable with her silicone implants and after several months of research decided to head south to have her breasts reconstructed.
Her first graft was in January. The last two — delayed because of COVID-19 — were in July and September. Khouri harvested fat from her belly and thighs first, then from other areas of her body, including her hips and flank. She says she wishes she had known this was possible before agreeing to her initial implants
“When you remove your breasts, it affects your life in so many ways,” said Townsend, 43. “But even after the first [graft] time, I didn’t feel like the bride of Frankenstein anymore. I could lay on my side or my stomach. It was amazing.”
FAT GRAFTING HAS BEEN AROUND FOR YEARS
Fat grafting, technically known as autologous fat transfer, is not new. It’s cited in medical literature dating back decades, and not only for the breast area.
This is how it works: Fat tissue is harvested from your body — usually where it’s more abundant, such as your thighs, buttocks and belly — by liposuction. New liposuction techniques have given surgeons better control, which has allowed them to remove the fat cells slowly and with less pressure.
“It’s less trauma to the fat cell,” Lampert says, which, in turn, gives the cells a higher chance at surviving at the transfer site.
After these fat cells are removed, they are purified and processed to prepare them to be injected. This is an important step as it promotes the fat cells’ survival in their new location. (Because fat cells can die and get absorbed into the body, surgeons often remove more than needed.) Once these fat cells are treated, they are then injected in the breast area.
When surgeons use fat grafting to supplement existing implants, it is usually a one-and-done procedure. For whole breast reconstruction, serial grafting is needed to slowly build up volume. These procedures are spaced every few months.
GOOD FOR PATIENTS WHO HAVE HAD PARTIAL MASTECTOMIES
In many ways, fat grafts are ideal for patients who have undergone lumpectomies or partial mastectomies.
“In the cases of mild asymmetry, we can address that quite beautifully,” says Dr. Devinder Singh, a
Susan G. Komen Miami/Fort Lauderdale Virtual More than Pink Walk begins at 9:30 a.m. Saturday. To register, go to http://www.info-komen.org/ site/TR?fr_id=8531&pg=entry breast-reconstruction surgeon from Sylvester Comprehensive Cancer Center at the University of Miami.
But in the right surgical hands and under the right conditions, it can also work for more radical surgeries, such as a mastectomies.
One of the procedure’s attractions is that it’s a safe, minimally invasive procedure, usually done in an outpatient setting.
“Patients like that it’s minimally invasive,” says Dr. Harry Salinas, a breastreconstruction surgeon with Miami Cancer Institute, part of Baptist Health South Florida. “Recovery is fairly quick and the pain is mostly in the liposuction area.”
He says it can take three to six months for the patient to end up with her actual breast size, once the swelling and the fat reabsorption are completed.
Fat grafting, say some surgeons, is not for everyone. Dr. Jonathan Weiser, a plastic and reconstructive surgeon with Memorial Healthcare Systems in Broward County, has found that in patients who have undergone radiation, the results of the procedure can be less predictable. Thin patients may offer less options for fat harvesting, too.
“You have to have the right candidate in the right situation,” he said.
Khouri, however, says he has been able to work on all kinds of patients. The key is the liposuction technique and “you should never graft more than the recipient can take,” he adds.
For Duchatelier, the fat graft that supplemented her new implants has given her a self-confidence boost.
“When I look at myself now, I feel blessed,” she says. “It has helped me turn a negative into a positive.”