There are a range of options for reconstruction following breast cancer surgery. When a mastectomy is performed, reconstruction can be achieved using various forms of implants, or with natural tissue taken from other parts of the body to re-form the breast. Whether or not a woman chooses to pursue breast reconstruction is a very personal choice. Many women experience an excellent quality of life without reconstruction. However, for some women, undergoing reconstruction after a mastectomy can help improve certain aspects of self-image and well-being.
A new option when reconstruction results are disappointing
Unfortunately, despite advances in plastic and reconstructive surgery, the final cosmetic result of breast reconstruction can occasionally be less than satisfying. Women may have contour irregularities (e.g. indentations, bumps, or ripples), asymmetry, or defects in the reconstructed breast resulting in a disappointing cosmetic appearance. For these women, a new option is available to help correct the deformity. This procedure is fat grafting, also called autologous fat transfer or lipo-filling. It involves removing fat tissue from other parts of the body using liposuction techniques, processing the tissue into a liquid, and then injecting it into the site of the reconstruction to help improve contour and appearance. The tissue is usually taken from the thighs, belly, or buttocks.
Actually, fat grafting is not a new procedure. The process has been available for quite some time. However, it was not used often due to concerns about its safety. The good news is that a growing body of data suggests that the procedure is safer than originally thought, especially because of new and improved techniques that have reduced complication rates.
Recent data from the largest clinical trial investigating patient-reported outcomes following fat grafting showed that fat grafting may improve outcomes rated by patients undergoing breast reconstruction. The findings were reported last year in JAMA Surgery. The study was conducted between February 2012 and July 2016 at 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women over the age of 18 who had had breast reconstruction after mastectomy and were available to be followed in the study for at least two years. All types of breast reconstruction procedures (implant and natural tissue) were included in the study.
A total of 2,048 women were evaluated across centers in the United States and Canada. The average age of study participants was 49.4 years. The study found that women who required fat grafting to correct deficiencies in their breast reconstruction were able to achieve equal rates of breast satisfaction, psychosocial well-being, and sexual well-being, compared with women who did not require fat grafting, despite the fact that their initial ratings in these areas were lower prior to correcting the deformities.
An interesting question not explored in the study is whether we should use fat grafting to improve cosmetic results after breast conserving cancer surgery (i.e. lumpectomy). This is still an area of controversy due to concerns about fat cells stimulating potential residual cancer cells, and therefore increasing the risk of cancer recurrence. Although the data are not conclusive — and in fact, emerging studies suggest that fat grafting may not impact local recurrence — the potential risk still limits enthusiasm for fat grafting following breast conserving surgery.
What else is important about this study?
This study is the first of its kind to provide patient-reported outcomes about fat grafting, and reflects a growing trend of incorporating patient-reported outcomes into clinical trials. Gaining a better understanding of outcomes from the patients’ perspective helps researchers and clinicians to design and deliver care that truly meets the personal preferences and treatment priorities of women diagnosed with breast cancer.
I’d like to thank my colleague Dr. Dhruv Singhal, a plastic surgeon at Beth Israel Deaconess Medical Center, for his contributions to this post.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
1 Corinthians 3:1-2 And I, brethren, could not speak to you as to spiritual men, but as to men of flesh, as to infants in Christ. I gave you milk to drink, not solid food; for you were not yet able to receive it. Indeed, even now you are not yet able
,1 Corinthians 13:11 When I was a child, I used to speak like a child, think like a child, reason like a child; when I became a man, I did away with childish things.
1 Corinthians 14:20 Brethren, do not be children in your thinking; yet in evil be infants, but in your thinking be mature.
Psalm 65:9 You visit the earth and cause it to overflow; You greatly enrich it; The stream of God is full of water; You prepare their grain, for thus You prepare the earth.
2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;
Proverbs 1:5 A wise man will hear and increase in learning, And a man of understanding will acquire wise counsel,
Acts 12:24 But the word of the Lord continued to grow and to be multiplied.
Proverbs 11:24 There is one who scatters, and yet increases all the more, And there is one who withholds what is justly due, and yet it results only in want.
Ezekiel 8:6 And He said to me, “Son of man, do you see what they are doing, the great abominations which the house of Israel are committing here, so that I would be far from My sanctuary? But yet you will see still greater abominations.”
Ephesians 4:16 from whom the whole body, being fitted and held together by what every joint supplies, according to the proper working of each individual part, causes the growth of the body for the building up of itself in love.
2 Chronicles 7:16 “For now I have chosen and consecrated this house that My name may be there forever, and My eyes and My heart will be there perpetually.
2 Corinthians 9:10 Now He who supplies seed to the sower and bread for food will supply and multiply your seed for sowing and increase the harvest of your righteousness;
Hebrews 5:12-14 For though by this time you ought to be teachers, you have need again for someone to teach you the elementary principles of the oracles of God, and you have come to need milk and not solid food. For everyone who partakes only of milk is not accustomed to the word of righteousness, for he is an infant. But solid food is for the mature, who because of practice have their senses trained to discern good and evil.
1 Peter 2:2 like newborn babies, long for the pure milk of the word, so that by it you may grow in respect to salvation,
Luke 8:14-15 “The seed which fell among the thorns, these are the ones who have heard, and as they go on their way they are choked with worries and riches and pleasures of this life, and bring no fruit to maturity. “But the seed in the good soil, these are the ones who have heard the word in an honest and good heart, and hold it fast, and bear fruit with perseverance.
Matthew 13:22-23 “And the one on whom seed was sown among the thorns, this is the man who hears the word, and the worry of the world and the deceitfulness of wealth choke the word, and it becomes unfruitful. “And the one on whom seed was sown on the good soil, this is the man who hears the word and understands it; who indeed bears fruit and brings forth, some a hundredfold, some sixty, and some thirty.”
Mark 4:19-20 but the worries of the world, and the deceitfulness of riches, and the desires for other things enter in and choke the word, and it becomes unfruitful. “And those are the ones on whom seed was sown on the good soil; and they hear the word and accept it and bear fruit, thirty, sixty, and a hundredfold.”
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