Fat grafting is an option for mastectomy patients choosing to go flat to optimize the final chest contour. Fat is liposuctioned from one part of the patient's body, purified, and re-injected under the chest skin to increase "padding" over the ribs and address contour irregularities created by the mastectomy. Fat grafting is not performed at the time of the mastectomy but as a separate procedure later.

Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.

There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, handling, and transplantation of the fat cells must be optimized to obtain the best long-lasting results.

Regardless of the fat grafting technique that is used, some of the injected fat will be reabsorbed over time (most studies quote reabsorption rates between 30% and 50%), but this can vary depending on the exact clinical situation and technique used. Patients must therefore be prepared to require more than one procedure for the best results. Additional risks of fat grafting include fat necrosis (some of the injected fat can turn hard), cyst formation (from oils released by the fat), calcifications on mammograms (usually easily differentiated from "bad" calcifications associated with malignancy), and pain at the liposuction site (from where the fat is removed). The discomfort experienced at the liposuction site can be greater than the chest area and last for a few weeks. 

Several independent studies have evaluated breast cancer patients over several years after lipofilling and concluded that fat grafting is oncologically safe in mastectomy patients and does not increase the risk of breast cancer recurrence.

Mastectomies can also leave excess soft tissue over the side of the chest known as "dog ears". These can be unsightly and bothersome but can be significantly improved through scar revision, further tissue excision, surgically rearranging the tissues that were left behind (such as "V-Y advancement"), or some combination of these techniques to achieve the desired flat chest contour. Recovery after these tissue rearrangement procedures is usually fairly straightforward and no harder than the initial mastectomy surgery, and often easier than recovery after breast reconstruction.

Content provided by PRMA Plastic Surgery | Center for Advanced Breast Reconstruction