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Resection of small cancers or potential areas of malignant change, through a lumpectomy excision, has become commonplace over the past decade in lieu of a more extensive mastectomy procedure. This has created smaller breast contour defects which are not always amenable to standard breast reconstructive techniques which are often better suited to larger mastectomy defects.

Fat injections, a commonly used technique in facial cosmetic surgery, may have applications in smaller breast contour defects. Fat injections require harvesting the patient’s own fat. It is then prepared by concentrating the number of fat cells to be injected into a syringe from which it is injected back into the body. Small tunnels are made with the needle to create linear tracks underneath the skin. Such ‘fat lines’ are more capable of surviving because they are thinner and can get a blood supply quicker. Such fat injection techniques have enjoyed great popularity over the past decade. While fat survival is not always guaranteed, the fat that does take is relatively permanent and is natural.

Such fat injections have more recently been applied to breast lumpectomy defects with good success. Because fat cells carry stem cells as well, they may help repair damage to surrounding breast tissue and skin often caused by the use of radiation in the prior treatment of the breast cancer. While this fat injection application is still considered a technique in development, it is a promising application of an aesthetic technique applied to breast reconstruction. How well and how long these fat injections last in the breast requires further study in larger numbers of patients. Also, calcifications may occur from incomplete fat survival and whether this interferes with breast cancer detection remains to be determined. But despite being in its early infancy of clinical use, I see using the patent’s own fat for all sorts of soft tissue needs, not just the breast, as a growing clinical technique.

Dr Barry Eppley

Indianapolis, Indiana

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