Rebuilding Breasts With Fat After Mastectomy

Every year about 1.6 million women (and over 10,000 men) somewhere in the world are diagnosed with breast cancer. Despite advances in breast cancer treatment, the first line of defense against this common type of cancer is removal of the tumor with a margin of healthy tissue around it. The size of the tumor determines how much tissue has to be removed.

Lumpectomy

When the tumor is less than 5 cm (about 2-1/2 inches) in diameter, sometimes the surgeon can perform breast-conserving surgery better known as lumpectomy.

The surgeon takes out the tumor and a margin of healthy tissue, usually about 1 cm (4/10 of an inch) around it. A pathologist looks at the tissue in the margin while the patient is still in the operating room, and if it contains cancer cells, the surgeon removes more tissue. 

This procedure is not possible if:

• The breast is small.
• The tumor is more than 5 cm in diameter.
• There is cancer in multiple locations.
• It is not possible to give radiation therapy after surgical treatment.
• The patient has already received radiation therapy in the location where the tumor is found.
• The patient is a woman in the first or second trimester of pregnancy.
• The pathologist keeps finding cancer cells in repeated removal of tissue during the procedure.

When lumpectomy is not possible, then the surgeon may have to perform mastectomy.

Mastectomy

Mastectomy is the removal of the entire breast. All of the breast is removed, sometimes along with nearby tissue.

In a simple mastectomy, sometimes called a total mastectomy, the surgeon removes the entire breast, including the nipple, but not the lymph nodes or the muscle tissue underneath the breast. Since 60% of women who develop cancer in one breast also develop it in the other, even if the other breast is not found to contain cancer, it may be removed in a procedure known as a double mastectomy. 

This procedure is performed when a test of sentinel lymph nodes finds the presence of cancer metastisized from the breast. The decision to perform a radical mastectomy is made on the basis of the pathologist's report during surgery.

Sometimes the surgeon performs a skin-sparing mastectomy, leaving the nipple intact. This procedure is only used when immediate breast reconstruction is planned, while the patient is still in the operating room. But how can a breast be replaced.

Older Techniques of Breast Reconstruction

Before about 1950, reconstruction of the breast after cancer surgery was not possible. Women were encouraged to wear "falsies" to give them a normal curvature at least when they were clothed.

In the 1960's, surgeons started using a procedure called expander implant breast reconstruction. The surgeon placed a silicone breast implant in the breast during surgery, but only inflated it some weeks later when the skin had healed sufficiently to withstand the procedure. The silicone produced a mound of flesh but could not give the breast normal color or feel or a nipple.

See Also: A Bizarre Mass On My Breast: Could It Be Cancer?

In the early 1980's, surgeons started using a procedure called the transverse rectus abdominus myocutaneous or TRAM reconstruction technique, removing muscle from the patient's thigh or buttocks and placing it under a flap of skin left during mastectomy. The procedure was and is usually successful, but since it is essentially two surgeries at the same time, very painful.

A Less Painful Approach To Breast Reconstruction

The problem with all the older approaches to restoring breasts is that they are traumatic and painful. Many women wake up from surgery extremely upset by unexpected pain. They become unhappy with their surgeons, they are less likely to comply with the rigorous demands of ongoing treatment, and, while no study finds that older methods of breast reconstruction increase death rates, they certainly do not extend life. But modern reconstruction methods are far less traumatic and far less painful.

It does not use unnatural substances such as silicone, it does not require additional surgery, and it does not have to be performed at the same time as the mastectomy. Also, it can be used to repair damage to the breast caused by lumpectomy. This method is called autologous transplantation of fat-derived stem cells or lipofilling. It uses abdominal fat, which is rich in naturally occurring stem cells, to rebuild the breast.

The breast naturally contains large amounts of strategically distributed fat. This transplant procedure, using the patient's own fat cells, cannot create a new breast, but it can result in a natural-looking, appropriately sized breast. When women do not have enough fat to create a new breast, their fat cells can be multiplied in the laboratory and then injected into the breast. The process of collecting them, through liposuction, is relatively painless and recovery times are fast. And no artificial materials are introduced into the body to rebuild the breast. The procedure isn't successful absolutely every time, but fewer than 1.2% (about 1 in 80) women receiving the procedure have to return to the hospital for treatment of complications. Only about 3% have any complications at all, usually death of fat cells at the injection site.

To take advantage of this procedure, it is important to know that:

• The fat used for lipofilling can be harvested from either the tummy or the thighs.
• Lipofilling requires at least a flap of skin to place the fat under. Extremely tight skin left after total or radical mastectomy may require additional treatments to prepare to accept the fat graft.
• Lipofilling is especially well suited to the complications of lumpectomy that have left the breast too small, missized in comparison to the other breast, or with an inverted nipple.
• Lipofilling usually is done long after the breast is removed. One study found that most women waited 3 years to have the procedure.

In a study conducted in France and Italy involving 534 women who had had the breast reconstruction, women who had lumpectomy and fat filling reconstruction were about 1% more likely to suffer cancer's return. Overall, about 2% of women had recurrence of cancer in the same breast, and about 3% of women had breast cancer to develop in the untreated breast.

See Also: Breast Cancer Prevention: Practical Aspects

It is important to discuss reconstruction options with your doctor before you have your mastectomy. Modern medicine can't give you a new breast, but it often can give you the illusion of a healthy breast, now with minimal pain and minimal risk of cancer recurrence.