Surgery after breast conserving surgery (lumpectomy or wide-local excision) to correct contour defects

LICAP (Lateral Intercostal Artery Perforator) and TDAP/TAP (Thoracodorsal Artery Perforator) Flaps

These techniques are used to improve the shape of the breast after a portion of the breast has been removed for cancer (lumpectomy or wide-local excision) by importing new skin and tissue to replace the volume and skin that have been removed.

These flap procedures involve moving tissue from near the armpit area or side of the back. The flap is made up of mainly skin, fat, and blood vessels. It is tunnelled with its blood supply attached under the skin below the armpit to the front of the chest. You will have additional scaring on your back and may have a patchwork appearance to the scaring on your breast.

Fat transfer (also called fat grafting, lipomodelling or liposculpting)

These are techniques may be used to improve the shape of the breast after a portion of the breast has been removed for cancer (lumpectomy or wide-local excision). This procedure is usually carried out under a general anaesthetic and involves using a special needle and syringe to remove fat (liposuction) from one area of the body (buttocks, flanks, abdomen, and thighs). The fat is purified (filtered) and re-injected into the breast to smooth out any defects.

There will be small incisional scars where the fat is removed from and injected into. There may be bruising and swelling, particularly in the donor site areas the fat is harvested (removed from) which can take a few weeks to settle. You may be asked to wear supportive garments (shorts or body-shaper knickers) to support the area the fat has been taken from. You may also be asked to wear a supportive bra for several weeks after the surgery to support your breasts.

There is a risk that the fat injected does not pick up a good blood supply and the fat cells become damaged and eventually die. This is called fat necrosis. Approximately 40% of the fat injected will be resorbed by your body. This means the body naturally absorbs the fat that has been transferred and sometimes the procedure needs repeating two or three times.

Guidelines on fat transfer in the UK are published by BAPRAS:

http://www.bapras.org.uk/docs/default-source/commissioning-and-policy/2012-august-lipomodelling-guidelines-for-breast-surgery.pdf

In the future when you have mammograms, please inform the Mammographer that you have had fat transfer surgery as this will assist with the interpretation of the images.

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