Fat replacement for craters via fat injections, grafts or flaps? Please help Drs

[spooreal]

Hello, I will likely have a revision by my surgeon in the near future due to a minor crater defect left above one of my nipples/mid breasts. There is still a little fat in the crater... therefore its not stuck to the muscle, but there is a depression and visible contour defect.

Based on my discussion, I have two options:

1. Mild lipo around the area to fix the contour. however, the problem with this is the other breast looks good and I dont want to have to touch it to match the fixed breast.

2. "Fat injections" are my other option posed by my doctor. Honestly, I am still confused about what this exactly is. He said its fat injected into multiple layers to place fat in the area. It apparently has a 50% success rate.

I am leaning towards placing more fat in as that seems to be more readily reversible in case of complications.

I have read Dr. Bermant's website and one of his pages on revision state the following:

"Repairing such extensive craters depends on what remains behind. This patient had enough nearby fat that Dr. Bermant was able to mobilize this tissue on its blood supply and move it back for a more natural contour on animation such as flexing, lifting arms overhead, activities, and sports."

1. Dr. Bermant and other doctors could you kindly advise what the procedure above specifically is?

2. What is the difference from fat injections if the fat comes from neighboring areas? Are sutures involved vs injections? Is the fat simply cut and placed into the proper area?

THANK YOU IN ADVANCE FOR YOUR REPLIES.

[spooreal]

Any replies are welcomed.

[hitchcock]

I don't want to hijack but add a question - do doctors add fat-flaps during the initial operation to prevent craters, or during revisions mostly? How do they decide whether to use fat-flaps or leave gland?

[Dr. Elliot Jacobs]

There are basically two ways to try to improve a crater deformity.

1. If there is adequate surrounding fat tissue, then a fat flap operation can be done.  This involves an incision around the edge of the areola.  Adjacent fat tissue is then dissected, leaving it partially attached to its blood supply.  The fat flaps thereby created are then pulled into the crater defect and sutured to one another.

2. If there is minimal available surrounding tissues, then the only method would be serial fat grafting, which might require more than one procedure (depending on the severity of the crater defect).

For both procedures, sometimes additional, very precise lipo of the surrounding areas can diminish the apparent depth of the crater.

Dr Jacobs