Winter Park plastic surgeon facilitates oncologic management of breast cancer
Winter Park plastic surgeon Jeffrey Hartog, MD, has become a “go-to” specialist for breast reconstruction, using novel tissue engineering procedures incorporating fat that can even restore sensation in the skin over the breasts.
“Fat grafting has revolutionized the breast reconstruction landscape and made it more accessible to women,” said Hartog, noting that unfortunately, only one in three women who have mastectomies have breast reconstruction. “Many don’t even know about breast reconstruction options beyond the traditional approach, particularly those who have undergone complex therapy, because many reconstruction procedures are complex and expensive, with fairly high complication rates, especially in the face of radiation. This is where fat grafting for breast reconstruction really shines.”
Oncologic management of breast cancer often includes adjuvant radiation therapy, Hartog noted. “From a reconstructive plastic surgery perspective, adjuvant radiation therapy presents a number of challenges,” he said. “Problems encountered include increased capsular contracture around implants placed under radiated tissue and distortion of the breast in lumpectomy patients that significantly compromises the concept of breast-sparing surgery in the first place. The incidence of reconstruction compromise and complications in the face of adjuvant radiation therapy is as high as 50 percent in some studies.”
Recent advances in autologous fat transfer techniques provide a relatively simple method of salvaging implant reconstruction complications, while also restoring lumpectomy defects and simultaneously reversing radiation-related tissue compromise. Autologous fat transfer is a low-risk, no-incision technique that can be performed as an outpatient procedure in most cases, Hartog pointed out.
“The discovery that fat is rich in stem and regenerative cells has contributed greatly to our understanding of the mechanism by which autologous fat transfer restores the vitality of tissue compromised by radiation therapy,” he explained. “We now understand that fat transfer provides both volume to the tissues through the adipocyte component and a true healing and regenerative component due to the action of the stem and regenerative cells associated with the microvasculature of the grafted fat.”
Staged fat transfer procedures may serve as an alternative for the full range of reconstructive procedures, from limited lumpectomy defects to full mastectomy reconstruction.
“We can also initiate fat transfer as an immediate reconstructive procedure at the time of a mastectomy,” he emphasized.
“The procedure involves a standard liposuction harvest procedure, filtration and washing of the fat and microdroplet fat injection into the recipient tissues,” he said. “Depending on the size of the defect, the number of fat transfer procedures may range from a single low-volume procedure for small lumpectomy defects to five or six procedures to reconstruct a radiated mastectomy defect. Fat transfer is useful in combination with breast implants to enhance the tissue thickness and quality over the implants. Consider this procedure, known as the lipoflap technique, an alternative to other tissue flap procedures.”
Very few limitations exist for candidates of fat grafting for breast reconstruction, as even very slim women will usually have some fat to add to the breast area, even if it is to just improve the tissue coverage over an implant.
The best time to reconstruct a breast is when weight is relatively stable, Hartog noted. “When fat takes, for the most part, it’ll respond to weight changes like it would where we took it from,” he explained.
Because fat is very rich in regenerative cells, substantial evidence shows a tremendous improvement in the quality of radiated tissue beds, said Hartog.
“It’s really something that needs to be brought out not only for reconstruction,” he said, “but also for women with lumpectomies and radiation that could benefit from the relatively simple procedure of fat removed by liposuction.”
