This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had reconstructive surgery on my right breast in 2008. I have a silicone implant, but it feels like a hard lump on my chest. I’m 62 and healthy. I don’t know if my insurance will cover it if I decided to have the natural reconstruction.

ANSWER: Usually your insurance will cover conversion of an unsatisfactory implant reconstruction to a reconstruction using your own tissue with no problem, but we always check first to be sure. If you wish, we can give you a call to discuss your situation in more detail. Many, many people are or have been in your situation, and we are usually able to help.

— Richard M. Kline, Jr., M.D.    

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Can the breast cancer gene develop cancer in the resisted fat tissue? Is it best to not have any sort of tissue whatsoever in the breast area? I also know fat from the tummy area has been used in reconstructing breasts for 10 years with no known problems as yet, as another solution.

ANSWER:  There are two ways to transfer the fat – as a single large “flap” with its own blood supply, which has been done in one form or another since the 1980’s (most recently the DIEP), or as fat “grafts”, which means taking the small particles harvested during liposuction and injecting them into the breast area through a needle. “Flaps” are time-tested, and no ill effects have been observed. “Grafts” may well be just as safe when used in breast tissue, but don’t have the benefit of having been used for decades yet, so we’re not absolutely sure. For many years it was taboo to inject fat grafts into

For many years it was taboo to inject fat grafts into breasts, because people were afraid the fat would adversely affect the radiologists’ ability to interpret mammograms. A few years ago, a consensus was reached that there really wasn’t much impact on reading mammograms, so people began cautiously injecting fat into breasts for various reasons (reconstruction as well as cosmetic augmentation).

Since we began using fat grafts more, we have learned that it does some interesting things. Fat is potentially a rich source of stem cells, which can transform into different cell types under certain conditions. As one example, we have observed that fat grafts sometimes seem to produce remarkable beneficial changes in previously radiated skin, and this is thought to possibly be due to stem cell effects. On the other hand, there is at least one study purporting to show an increased risk of local recurrence when fat grafts are used to reconstruct partial breast defects after lumpectomy.

The study is controversial, but it has raised concerns among many surgeons about injecting fat into breast tissue in general. No one is quite sure what is potentially going on with stem cells in fat grafts, and no one is quite sure how they may affect residual malignant or pre-malignant cells in breast tissue. The potential ramifications are enormous, because while DIEP and other flaps are large, complicated procedures, fat grafting is extraordinarily easy, and a there is a lot of interest in it for that reason alone.

I haven’t read a good explanation of why fat transferred with its own blood supply (flaps) should behave differently than fat particles which induce a blood supply to grow into them (grafts), but that doesn’t mean there isn’t a difference. To complicate it further, when a flap is transferred (or even when a breast reduction is done), small particles of fat are de-vascularized initially but ultimately survive as grafts, yet no problems have been observed to date.

I realize now that you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.

Hope this helps.

— Richard M. Kline, Jr., M.D.    

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!