Cornwall Breast Surgeon Iain Brown
Cornwall Breast Surgeon Iain Brown

Lipomodelling

What is Lipomodelling?

Lipomodelling is a technique that involves moving a patients own fat from a ‘donor site’ area, treating and refining the ‘harvested’ material and then transferring it or ‘grafting’ it to the breast.

Lipomodelling aims to improve the shape, volume, profile and consistency of the area treated and may be used to rejuvenate, regenerate and reconstruct the breast. The other terms used for this procedure are fat transfer, micro fat grafting, fat injection and lipofilling.


Who Is This Procedure Suitable For?

After Breast Conservation Surgery:

  • Patients who have had breast conservation surgery for cancer (wide local excision/lumpectomy with or without mammoplasty) and who have significant deformity, contour or volume defects or asymmetry. These problems are often worsened over time due to the progressive changes in the breast tissue due to radiotherapy.

After Breast Reconstruction Surgery:

  • Patients who have had a breast reconstruction (either with implants, a tissue flap or a combination of both). Lipomodelling may be beneficial to improve volume or contour irregularities and thus improve the overall outcome of the reconstruction.
  • Lipomodelling may be recommended by your surgeon as a planned stage in your reconstruction plan. It may be possible to plan lipomodelling as a separate operation some time after your flap based (autologous) reconstruction to provide extra volume or improve shape without resorting to using an implant (hence “an implant free reconstruction”

In Preparation For Possible Breast Reconstruction:

  • Lipomodelling may be used to improve the quality of skin, and other tissues damaged by radiotherapy. After mastectomy and radiotherapy this may improve the tissues sufficiently to allow a subsequent reconstruction which might not have otherwise been possible

In Patients With Developmental Breast Or Chest Wall Deformities:

  • Lipomodelling may be used to help correct congental/developmental contour, shape or volume defects of the breast or chest wall eg in Poland’s Syndrome, Tuberous breast deformity, pectus excavatum. It may be possible to use it in conjunction with or in place of silicone implants.

Is Lipomodelling suitable for me?

  • Certain medical conditions may make lipomodelling less safe. As lipomodelling may require more than one procedure a patient must be deemed healthy enough for repeated procedures under general anaesthesia.
  • It is not recommended to perform lipomodelling in smokers. This is not just because of any potential anaesthetic risks. There is an increased risk of healing problems, graft retention ‘graft take’ and a likely increased risk of infection and fat necrosis (lumps and cyst development.
  • Patients taking certain medications may have an increased risk of bleeding or infection eg antiplatelet blood thinning medication (aspirin, dipyridamole), non-steroidal anti- inflammatory drugs (ibuprofen, diclofenac etc), anticoagulants (warfarin) as well as cytotoxic and immunosuppressant drugs.
  • Patients must have adequate amounts of fat to donate and there must be appropriate donor sites for the amount of fat transfer required without damage to underlying structures and poor aesthetic outcomes
  • Patient must be advised not to be actively dieting at the time of fat grafting and in the early postoperative period. This can compromise successful initial graft ‘take’ as well as leading to a reduction in the volume of fat retained over time

How is it done?

Fat is taken or ‘harvested’ from your own body, often the lower abdomen, thighs or hips in a similar way to conventional liposuction but using gentler techniques to prevent damage to the delicate fat cells. This is done through tiny cuts in the skin.
The removed fat is then concentrated and purified to remove unwanted material and fluid. The treated fat is then injected into the treatment ‘recipient’ area ie. ‘grafted’ using very small volume injections. The graft is injected as a complex three-dimensional lattice to build a fatty scaffold for new fat to grow into.

This procedure is usually done under general anaesthetic in one or more sessions depending on the amount of fat graft needed. It is done as a day procedure or with an overnight stay.
This procedure is normally performed 2-3 years after the initial treatment for cancer but this may vary in certain situations. Usually patients should have had a normal mammogram prior to this procedure.

Are there any side effects or complications?

Most patients do not have any problems but you should be as fit as possible before surgery, not actively dieting and preferably be a non smoker.

Possible Complications To Be Aware Of Include:

  • Swelling and bruising at the donor site. This can take one or two weeks to settle.
  • The treated areas can be numb or over-sensitive for several weeks. It is rare but possible, that there is some permanent numbness at the donor site area. This almost always gets smaller over time but may not resolve completely.
  • Some of the fat injected is naturally lost over time and the procedure may need to be repeated. Contour irregularities may occur but these should settle in time.
  • Fat necrosis - 3% of patients develop this. This is where some of the fat injected doesn’t survive and repairs itself forming chalky deposits, or oil cysts which are felt as lumps. This may need assessment when it happens.
  • Infection is possible as in any surgical procedure but it is uncommon.
  • Damage to implants during fat injection is possible. This would require further surgery to replace the implant.
  • “Guttering” or unevenness of the skin in the donor site due to fat harvest very close to the skin is very rare
  • Pneumothoax or air leak outside the lungs, peritonitis due to bowel perforation, and fat embolism where fat gets injected into blood vessels are extremely rare but significant theoretical complications.
  • There is theoretical concern about any possible recurrence of breast cancer after lipomodelling in the long term, although there is no evidence in the published reports.
  • There may be new changes on mammaograms after surgery. This is usually due to calcium in areas of fat necrosis where some of the grafted fat has not taken fully. These changes are usually very obvious to expert breast radiologists and nothing further needs to be done. There is however naturally an increased chance of requiring a breast biopsy if there is any uncertainty about new mammogram changes.

Post Operative Recovery
You should rest for 24 hours and then increase your activity. Normal non-strenuous activity can be resumed in 2-3 days. You may have stitches to close the incisions which may have to be removed in 7-10 days if they are not dissolvable.
It is advisable to wear support underwear over the donor area for 4-6 weeks to control the swelling and bruising. It will also help with the contouring of donor area. Please bring this with you to the hospital. Ensure your bra does not put pressure on the lipomodelled area.
Pain can be controlled with usual painkillers which will be given to you at the time of discharge. (Do not exceed recommended dose)


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Cornwall Breast Surgeon