Lipomodelling

What is lipomodelling?

Lipomodelling is the process whereby fat is taken from one area of your body using liposuction, processed and transferred to another area. It may sometimes be called lipofilling, fat transfer or fat grafting.

Lipomodelling aims to increase the volume of the recipient area or correct a contour defect of the breast or chest wall. Lipomodelling can be performed for several reasons; as part of breast reconstruction, to correct a breast contour irregularity or to improve the look and feel of the breast. The result can give a soft, natural appearance and feel. The amount of fat that can be injected in a single session varies and sometimes requires repeat procedures (termed staged procedures) to achieve the desired results. The fat transferred is laid down as a graft and blood supply grows into the fat with time to keep it alive.

What does the procedure involve?

Fat is taken from your own body, normally from your tummy, hips or thighs using liposuction techniques. Liposuction is where fat is removed with the aid of suction through a slim needle through tiny incisions (cuts) in the skin. The exact area (or donor site) will be decided upon by you and your surgeon after consultation. The fat is then processed to make it suitable for injecting into the irregularity or defect (recipient area) by your surgeon through tiny incisions. You will have scars at the sites of fat harvest and injection. Lipomodelling is usually performed under general anaesthetic.

What are the side effects or potential complications?

As with any surgical intervention, there are some risks and these will be fully discussed with you during your consultation. These include:

Short term, common risks

• Pain at the site of fat harvest/liposuction (usually simple painkillers are sufficient)
• Bruising, bleeding, or haematoma (blood collection requiring aspiration or repeat surgery)
• Infection and wound healing problems (this is rare but the risk is higher in patients who smoke or have diabetes)

Short term, very rare risks

• Damage to underlying structures e.g. breast implant rupture, pneumothorax (air between the lungs and chest wall)
• Fat embolism – due to accidental injection of fat into the small blood vessels which can then float to the lungs
• Other general risks such as anaesthetic risks, blood clots in the lungs or legs

Long term risks

• Fat necrosis, oil cyst formation – this is the formation of a hard lump due to poor or no blood supply to the grafted fat. This should be assessed by your clinical team, and occasionally needs intervention.
• Calcification (calcium build up in tissues) of fat droplets is the most common complication (affecting 1.5-10% of patients) due to fat necrosis. This can be seen sometimes on future mammograms. Occasionally, a biopsy is required to make sure the changes seen are due to the fat grafting. It is therefore important to tell the x-ray team (radiographers) undertaking the mammograms that you have had previous lipomodelling.
• Scarring: scars may be hard initially but tend to soften with time. Some scars can be lumpy or raised or itchy (hypertrophic or keloid scarring). Your surgical team can give advice if you are concerned about your scars.
• Under-correction (not enough fat transferred) or over-correction (too much fat transferred). This means that your breast may never have the desired volume or shape despite the surgery.
• Asymmetry – Breasts are naturally not exactly the same size and shape. If you have had surgery on one breast it may not age the way the opposite breast does leading to increasing differences with time between the two sides.

Donor site complications

• Bleeding, bruising, haematoma (blood collection that may need surgical intervention or aspiration)
• Persistent pain or numbness
• Infection, wound healing problems (especially in patients who smoke or have diabetes)
• Contour deformity from harvested fat: this happens when the fat that is removed from a part of the body (like the abdomen, thighs, or buttocks) leaves the area looking uneven, with dents, hollows, or irregular shapes. It’s a possible side effect of the fat removal process, but surgeons aim to minimise this by using careful techniques during the procedure.
• Very rare - damage to underlying structures e.g. damage to organs such as the bowel or spleen

Oncological safety

There is no evidence that lipomodelling can adversely affect future breast cancer detection, surveillance or recurrence rates. There is no evidence to suggest that fat injection into the breast tissue is unsafe. We currently do not have data on newer techniques such as immediate lipomodelling at the time of cancer operation.

How do I prepare for surgery?

• You will have a preoperative assessment that will identify which medication you should stop taking and when.
• Photographs: Pre-operative (and post-operative) photos are recommended for your medical records, teaching or publication (with your consent)
• Smoking: if you are a smoker, you should stop at least four weeks before surgery to try and minimise postoperative complications and fat transfer loss, which are more common in smokers.
• Compression garments: You will need to bring in some High Waist Firm Control Support Pants, cycling shorts or body shapers to wear day and night during the next 4-6 weeks to minimize the extent of bruising after surgery (Fig 1). These are not provided by the hospital.
• Bra: you will need to bring a sports, non -wired bra to wear day and night for the next 2 weeks. These are not provided by the hospital

It is important to ensure your bra does not put pressure on the lipomodelled

On the day of the operation

• Admission: you will receive detailed information on this process by the theatre booking team. On the morning of surgery, you will be seen by your anaesthetist and your surgeon. The surgeon will confirm your final consent for the procedure and mark the donor site and recipient areas for the surgery.
• Time: the operation itself will take on average between 1 to 3 hours and will depend on whether you are having other procedures combined. This should be discussed with your surgeon prior to the surgery. In addition, anaesthetising you and waking you up safely will take some time.
• Length of stay: the procedure is usually performed as a day case. You can go home once you are stable and have fully recovered from your anaesthetic.

Post-operative expectations

• Dressings: In most cases medical skin glue with or without brown tape is the only dressing required. However, additional dressings may be put on to help keep and support the breasts in a better position for a few days. You will be advised to wear a snug supportive bra day and night for 4-6 weeks to preserve the shape that is achieved during surgery, providing this is comfortable to you.
• Drains: You will not have a drainage tube after this surgery.
• Healing: Healing is usually quick and uncomplicated. Any stitches are removed or dissolve on their own within 7-10 days. You may experience some bruising around the liposuction areas but this will decrease significantly in 10 days. Although most of the bruising and swelling usually disappears within a week, some swelling may remain for three months or more.
• Overall recovery: Initially the breast will appear bigger with some bruising and swelling but this will start to settle from week 2 onwards and can take a few months for the final planned shape and texture. Your surgeon may have ‘overfilled’ your breasts/defect area to compensate for the fact that up to 40% of the fat injected is naturally reabsorbed by your body. In some patients, this natural reabsorption continues over time and you may require more than one treatment.

You may feel well immediately after the procedure or need a day or two to recover and you should be back at work within a few days. Strenuous activity should be avoided for about a month as your body continues to heal.

Your breast may never achieve the size or shape you would like using this procedure even if the procedure is repeated.

• Exercises and Dieting: Your breast care nurse or a physiotherapist will advise you regarding necessary exercises but after 3-4 days, you should be able to undertake some gentle exercises. We do not recommend active dieting for a few weeks before and after fat grafting.

Follow-up

A follow up is usually arranged in 2 weeks for a wound check and then in 3 months to assess how well the fat has taken in the grafted area. We will also check the donor sites. Sometimes, further sessions of lipofilling are required, and this will be assessed during this appointment. If no further sessions are required, you will be seen again in 1 year.

It is best to avoid having a mammogram for the first 6 months after the procedure. If you are due a mammogram within this period, please discuss with your surgical team.

Contacts/further information

Should you have any further questions about the procedure or follow up, please contact the Breast Care Specialist Nurses.

If you query is regarding a surgical date, please contact the surgical booking coordinators.

Breast Care Nurses: 01223 349884

Surgical booking coordinators: 01223 5869

Appointments team: 01223 217627

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay, if you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information is available on our website: MyChart