Fat-Grafting Use in Innovative Breast Reconstruction

Plastic Surgeon in Pacific Northwest Uses Natural Materials for Less Scarring, Muscle Damage

Since early 2014, Jennifer Murphy, MD, a board-certified plastic surgeon and chief of Plastic Surgery at Kaiser Permanente Northwest, has been one of the few plastic surgeons in the world to innovate the use of fat-grafting techniques for total breast reconstruction.

Her initial exploration into this type of surgery actually stemmed from a patient’s request for an alternative to the typical reconstructive surgery options familiar to most plastic surgeons. Dr. Murphy recalls that this patient came to her with bilateral mastectomies and uneven contour, but did not want either of the two common types of reconstructive procedures—the flap procedure or traditional implants.

Dr. Murphy immediately thought about other cases where she used fat grafting to fill in contour defects for breast reconstruction or for contour defects on the face or head for patients suffering from trauma or painful scarring.

“While we had seen success in this small-scale fat grafting, no one had really recreated an entire breast with this technique,” says Dr. Murphy. “I began to research what made fat grafts survive, in the event that this technique would be a good solution for my patient.”

Total breast reconstruction helps women to feel ‘normal’ after having had a mastectomy.”

— Jennifer Murphy, MD, chief of Plastic Surgery

Both Dr. Murphy and her patient were ultimately thrilled with the outcome and the doctor was encouraged to work with her partners to expand this offering to other women seeking an alternative to implants or the more painful flap procedure.

What is Fat Grafting?

The entire fat-grafting process is more involved, as it requires four to five surgeries each spaced over three to four months apart to complete (about one to two years total). Each surgery is an outpatient procedure consisting of liposuction all over the body and then redistribution of the removed fat into the breasts. After a total operation time of about an hour and a half, the patient is free to go home.

Most patients describe soreness for about a week, but only need pain pills for the first one or two days. Compared with the traditional alternatives, and even considering the higher number of surgeries, the patient typically experiences less scarring and nearly zero muscle damage.

“After a lot of research, I chose fat grafting because it seemed like the best choice for me even though it was not a quick process,” says Joyce, another Kaiser Permanente patient who underwent the procedure. “I cannot begin to tell you how excited I was when I was all finished because not only do my breasts look fantastic, they also feel very natural.”

Dr. Murphy does caution that this type of procedure may not be a good fit for everyone. “Women who want large breasts aren’t usually fit for this type of procedure, as we can usually only add 300-400cc’s of tissue (roughly a B-cup). In addition, if the patient has had radiation the results are much less predictable.”

I cannot begin to tell you how excited I was when I was all finished because not only do my breasts look fantastic, they also feel very natural.”

— Joyce, Kaiser Permanente patient

Fat grafting for breast reconstruction is also not without its downsides. For example, the higher number of procedures, variability of results, as well as its lack of pervasiveness in the medical field can all serve as deterrents for some. To help answer the questions and quell anxieties of prospective candidates, Dr. Murphy originally asked her first few patients to talk to potential patients about their own experiences and share their advice. These patients overwhelmingly agreed to serve as ambassadors and spread the word about this technique to other Kaiser Permanente members.

In regard to upsides, Dr. Murphy foresees limited long-term maintenance for her patients because the breast is filled with the patient’s own fat and no foreign objects are inserted into the body during the procedure. She also predicts that the breasts will likely become more natural over time and should age similarly to natural breasts. Dr. Murphy adds that she often works alongside the general surgeon to coordinate that the first fat-grafting procedure occur at the same time as the mastectomy, limiting at least one of the patient’s visits.

A Passion for Helping Patients

“Total breast reconstruction helps women to feel ‘normal’ after having had a mastectomy,” says Dr. Murphy. She has a passion for helping patients erase the visual reminder of the trauma their bodies endured in response to a cancer diagnosis, or like in Joyce’s case, a genetic likelihood of a cancer diagnosis. “I find joy in helping them conquer their disease.”

Dr. Murphy says she also believes the total costs over a patient’s lifetime may be less for this type of reconstruction since there is no long-term maintenance needed. Implants, for example, may need to be replaced as often as every 10 years. While there are more surgeries involved in fat grafting, operative risk is very low each surgery. As a result, there are likely fewer complications requiring another operation.

Dr. Murphy ultimately wants to spread the word about the upsides to this type of procedure, and wants to publish a paper with data that outside organizations can use to convince them that it is a great alternative for some patients. To date, she has treated more than 40 women and plans to continue to give her patients the option of a surgery they likely could not explore elsewhere.