For Breast Reconstruction and Facial Rejuvenation
By Kymberly Taylor
Most of us have been taught that “belly fat” is something to lose as soon as possible. However, for a woman considering breast reconstruction after a disfiguring mastectomy, her fat is indispensable. For doctors, fat, or adipose tissue, is a powerful tool used to help rebuild the breast and heal and rejuvenate skin. It has the following advantages. It naturally integrates into injured tissue, is not usually rejected by the immune system, is easy to access, can be removed without harm to the patient and is pliable. Though not quite like clay in the potter’s hand, it can be manipulated and contoured.
Dr. Bernard W. Chang, director of Baltimore’s Plastic and Reconstructive Surgery at Mercy Hospital has come to appreciate fatty tissue and its receptivity to transplanting. A specialist at microvascular breast reconstruction and deep inferior epigastric perforator (DIEP) flap surgery, he uses state-of-the-art microsurgery to create a breast using a woman’s own natural tissue taken, ideally, from the abdominal area. He has helped to pioneer and refine the DIEP flap since its inception in the 1990s.
A 2016 study published by the National Institute of Health helps put this advanced surgery in perspective. “The concept of this so-called ‘perforator flap’ or DIEP flap has somehow revolutionized breast reconstruction by maximizing the amount of safe tissue transfer, yet minimizing donor site morbidity.” The study goes on to note that “abdominal tissue
is very suitable for breast reconstruction, since many patients have a certain abdominal excess of skin
Chang explains DIEP flap surgery is performed usually immediately after a mastectomy while the patient is still on the operating table. He moves a flap of skin, fat, and blood vessels from the lower abdomen to the mastectomy site. Using microsurgical techniques, he joins the old skin to the new, meticulously sewing blood vessels approximately 2 millimeters in diameter together. It is a delicate, artistic procedure for at the same time he is building and shaping the breast. He has found that “smaller pieces of fat” bond much easier than larger sections, so the process is painstaking.
Chang, who worked at Johns Hopkins for many years before being asked to head up the Breast Reconstruction and Restoration Center at Mercy says that the discovery that fatty tissue was ideal for transplanting was a game-changer for this particular surgery. “In the old days, we had to sacrifice the patient’s muscles. The advantage of DIEP flap breast reconstruction is the abdominal muscles are not cut or moved often resulting in a faster recovery.”
The surgery is complex and the overall process takes longer than choosing to reconstruct the breast using implants, he notes. If you wish for a shorter surgery or just are not up to it, implants may be ideal. He notes that today women have many options when it comes to breast reconstruction and that it is important to discuss them carefully with a practitioner. With DIEP flap, he says, “It is a commitment and it takes several steps to get there, but a good choice if you like the idea of using your own tissue.” If all goes well, the existing skin bonds with the new over a four- to six-week period. Additional minor surgery to revise the shape and symmetry of the breasts may be needed as well as minor surgery to create the areola and nipple.
A tattoo artist may be called in to make everything look natural. Chang works often with the renowned Vinny Meyers, who resides in Baltimore and is flown across the country to assist celebrities and in cases when perfection is called for. Chang says the surgery for one breast takes four to six hours compared to earlier similar breast reconstruction surgeries lasting eight to 10 hours. One of the benefits of the surgery is a “tummy tuck” for the patient and the breast lasts a lifetime.
Chang depends on adipose tissue for successful microvascular surgery. His partner Dr Craig A. Vander Kolk, Director of Cosmetic Medicine & Surgery uses its capabilities for autologous fat grafting—where a patient’s fat is harvested and then reintroduced into tissue that needs to be corrected. He uses fat grafting to repair holes left by lumpectomies, refine breast reconstructions, heal scars from skin cancer, and perform facial rejuvenation with or without a surgical facelift.
Vander Kolk worked for 20 years at Johns Hopkins Hospital specializing in the study and treatment of facial differences. It is not an exaggeration to infer that he loves fat, or rather what fat can do. “We are now using fat for all kinds of things, for trauma reconstruction, legs, arms, faces, and cosmetics as well,” he says.
He explains that he often supplements a facelift with fat injections to attain a natural look. After the fat is removed from the patient, it is processed to make it almost 20 percent more effective, he says. “We know there are rejuvenating cells there … we aspirate out the fat, spin it down, and concentrate those cells. We are able to increase our results from 50 or 60 percent to 70 percent … so for radiation patients, this decreases scarring that’s occurring.”
He recalls a patient who had a car accident 20 years ago and had some facial disfiguring and scarring. He extracted fat cells from one area of the face and then injected it into the problem areas. Two things happened. Her scarring was minimized and she looked younger. “It was successful. I was able to erase an accident that happened twenty years ago and turn back the clock ten years on the aging face.”
“It is really like sculpting because you take fat from one area of the face and inject it in another,” he says, adding that facial surgery is changing and the “organic” look is in. “I like my facelift patients to look natural, not that startled or take-off-in-the-shuttle look. In the old days, we would pull the skin tight. The goal now is to elevate the skin up, reposition deeper tissues to better spots and then refill them with the fatty tissue.”
Using fat to plump up the face is not new. A patient of Dr. Steven Hopping in Washington, D.C., had fat injections in the 1990s and shares, “I had that done and it was wonderful. It lasted a long time, longer than other injections I have had.” She is no stranger to the world of facelifts and injectibles and would have it done again. In fact, she wonders what the fuss over fat injections is all about.
The Mayo Clinic of Regenerative Medicine explains that we know more about the composition of adipose tissue today than 10 years ago. It naturally contains progenitor and stem cells, which are the active and regenerative part of fat. Unfortunately, marketers use the term “stem cell” to infer skin will miraculously rejuvenate and may be the fountain of youth. Doctors dismiss this hyperbole. There is evidence that fat cells reinjected into the body add volume, help heal and replenish tissue. Scientists sense great potential but don’t yet know what adipose stem cells can really do. Clearly, there is a long way to go.
In the interim, please be nicer to your fat. Doctors use this organic gold successfully to rejuvenate aging faces and bring hope to burn victims and patients battered after a mastectomy and rounds of disfiguring radiation and chemotherapy. It is exciting to stand by as researchers continue to unlock its mysteries.
Dr. Bernard W. Chang and Dr. Craig Vander Kolk, Cosmetic Medicine and Surgery at Mercy, cosmeticmedicineatmercy.com.
Illouz, Y. G. “Breast Cancer Treatment by Adipose-Derived Stem Cells: An Experimental Study. Journal of Stem Cells 9, no. 4 (2014): 211–17, https://www.ncbi.nlm.nih.gov/pubmed/25942336.