Breast lipomodelling

Lipomodelling, also called lipostructure or lipofilling, is an autologous fat transfer.

Frequently asked question

To date, there is no evidence to suggest that fat transfer could promote the development of breast cancer. However, it will not prevent a cancer from occurring should one arise. Each patient has her own baseline risk of developing breast cancer, which depends in particular on her age, family history and breast density. She must also understand that every precaution should be taken to minimise the risk of coincidental timing between the occurrence of cancer and lipomodelling (strict assessment performed before the procedure by a breast imaging specialist; strict follow-up at 1 year, then repeated at 2 years and possibly 3 years). In this spirit, any patient requesting breast lipomodelling undertakes to complete the preoperative breast imaging work-up (mammogram, ultrasound) and, above all, to undergo the reference examinations (mammogram, ultrasound) at 1 year, 2 years and, where appropriate, 3 years, in line with the breast radiologist’s recommendations.

Indications

This technique is suitable only for specific indications and requires that the patient has a sufficient ‘adipose reserve’ to allow fat harvesting under good conditions. Very, very slim patients are therefore not good candidates for this technique. It may meet the expectations of a patient seeking a modest increase in breast volume or wishing to restore a more harmonious contour to a ‘deflated’ breast (after weight loss, pregnancy or breastfeeding). This technique has two major advantages: – it provides an increase in breast volume, admittedly modest, but completely natural, with no foreign body, and without giving the appearance of an artificial breast – it also allows treatment of any localised, disharmonious fat excesses at the same time (the fat-harvesting sites). As before any breast surgery, a clinical examination of the breast tissue must be carried out by the surgeon to detect any pathological process. Specific breast imaging tests (mammogram and/or breast ultrasound, and MRI if needed) are required to detect any suspicious abnormality that would warrant the additional opinion of a qualified breast specialist and would temporarily contraindicate breast lipomodelling. If all these precautions are taken, the operation can be considered calmly and without second thoughts. When the procedure is purely cosmetic, it is not covered by health insurance. In reconstructive breast surgery, by contrast, health insurance may cover breast malformations or deformities, which can be congenital (genetic or familial), caused by trauma (burns, accidents), or occur without any currently known explanation (Poland syndrome, tuberous breasts, pectus excavatum, etc.).

Before the procedure

The treatment plan is developed jointly between the patient and the surgeon. In particular, the expected aesthetic benefit, the limits of the technique in terms of volume gain, its advantages, disadvantages and contraindications will be discussed. A careful clinical and photographic assessment is performed. – A precise radiological assessment is carried out by a radiologist specialising in breast imaging and familiar with the radiological features of breasts that have undergone lipomodelling. If possible, the same radiologist will perform the reference examinations that must be carried out some time after the procedure. – The usual preoperative work-up is performed in accordance with the prescriptions. – You will see the anaesthetist in consultation no later than 48 hours before the procedure. – No medicine containing aspirin or an anti-inflammatory should be taken in the 15 days preceding the operation.

Principles

Breast lipomodelling is usually performed under general anaesthesia because several anatomical sites are involved during the same operation: – the harvesting areas (for example: buttocks, hips, abdomen or outer thighs [saddlebag area], inner thighs, knees) – the breasts.

Each surgeon uses a technique of his or her own and adapts it to each case to obtain the best results. However, some common basic principles apply. The choice of donor sites also depends on the amount of fat deemed necessary and on the available donor areas. Fat is harvested as atraumatically as possible, through small incisions using a fine suction cannula. The harvested fat is then centrifuged to separate the intact fat cells that will be grafted. The fat transfer is performed using microcannulas and a very specific, delicate technique designed to traumatise these living cells as little as possible (the graft take is estimated at 40 to 70% depending on the patient). The duration of the operation depends on the number of donor sites, the amount of fat to be transferred, and any change of position during the procedure (prone and/or supine). It may vary from 1 hour to several hours depending on the case.

Postoperative course

Pain is generally moderate, but may be temporarily quite marked at the donor sites. Swelling of the tissues (oedema) at the harvesting sites and in the breasts appears progressively and will usually take on average 1 to 3 months to resolve. Bruising (ecchymoses) appears within the first few hours at the fat-harvesting sites and resolves within 10 to 20 days after the operation. Some fatigue may be felt for 2–3 weeks, especially in the event of significant fat harvesting and liposuction. After the oedema and bruising have subsided, the result begins to become apparent around 2–3 months after the procedure.

The result

It is assessed 4 to 6 months after the operation. It is most often satisfactory whenever the indication and technique have been appropriate: the operated breasts generally have greater volume and a more harmonious contour. The body shape is also improved thanks to liposuction of the donor areas (hips, abdomen, outer thighs, knees). A second session of lipomodelling can be considered a few months later if necessary (and if possible given the available fat donor sites), to further increase breast volume or improve shape. Provided the fat-cell graft takes successfully, these cells will remain alive. Lipomodelling is therefore a lasting technique, since the adipocytes grafted in this way will live as long as the surrounding tissues. However, these fat cells will change in line with the patient’s adiposity (if the patient loses weight, the added volume will decrease). Normal ageing of the breasts is not halted and their appearance will change naturally over time.

Complications

Although undertaken for predominantly aesthetic reasons, breast lipomodelling remains a genuine surgical operation, which implies the risks associated with any surgical act, however minor. You will see an anaesthetist in consultation before the operation to minimise them as much as possible. By choosing a qualified and competent Plastic Surgeon trained in this type of procedure, you minimise these risks as far as possible, without eliminating them completely. In fact, true complications are rare after high-quality lipomodelling: great rigour in patient selection and in surgical execution is essential to ensure effective, real prevention in practice. Infection is normally prevented by prescribing antiseptic showers to be taken at home before the operation. A pneumothorax (air in the chest cavity due to trauma) may occur very, very exceptionally and, if significant, requires specific treatment (drainage). Injury to intrathoracic organs (heart, vessels) is theoretically possible, but has never been observed in normal practice when performed by a surgeon trained in this technique. Areas of firmness (fat necrosis) may rarely appear; these are localised ‘indurations’ due to breast ‘scarring’. SMOKING IMPAIRS HEALING. Smoking should therefore be stopped or greatly reduced if you wish to minimise resorption of the fat grafted to your breasts. Because the transplanted fat tissue remains alive, it is naturally subject to weight variations. In the event of significant weight loss, breast volume will decrease. Conversely, in the event of significant weight gain the breasts may increase in volume. A degree of weight stability is therefore recommended to maintain a stable result over time. Overall, the risks should not be overestimated, but simply an awareness maintained that any surgical procedure always carries a small element of uncertainty. Choosing a qualified Plastic Surgeon trained in this type of procedure ensures he or she has the training and competence required to avoid these complications as far as possible and, should they occur, to treat them effectively.