This is a summary of the video and podcast interview with Dr. Tim Matatov of Southwest Breast and Aesthetics in the Phoenix, Scottsdale, Arizona area. When I see hundreds of views of a video and close to two hundred podcast downloads I also like to provide a written summary for readers to hit on all learning modalities and preferences. I will include the YouTube video of Achieving Symmetry and Understanding Fat Grafting in this blog post.
You can listen to the podcast here:
How Mastopexy Achieves Symmetry in Breast Reconstruction
We begin with a topic that is often asked about in the breast cancer community served at DiepCFoundation, mastopexy in the setting of breast reconstruction. A mastopexy is a breast lift. Dr. Matatov points out that whether a person has a single breast reconstruction with their own tissue, and implant, or oncoplastic reconstruction, sometimes the contralateral breast will not match their reconstructed breast. Besides the cosmetic reasons there are also some functional issues. As is often said in plastic surgery, the goal is form and function.
There are times when a patient cannot find a bra that will cup one breast and not the other breast. He differentiates between a reduction and a mastopexy. A reduction is taking the skin and the gland itself whereas a mastopexy mainly is removing the skin and the surgeon might remove some of the gland. These are reasons to perform a mastopexy or reduction in the setting of breast reconstruction: symmetry, function, and psychological reasons. A patient wants to look and feel like they did before reconstruction with as close to matching breasts as possible which is a quality-of-life issue.
Mastopexy Procedures Used to Achieve Symmetry
Dr. Matatov describes the following types of mastopexy. This could be a point of discussion for patients during consultation for their breast reconstruction. A link to each procedure is provided for further reading.
- Crescent Mastopexy: This is a nipple repositioning procedure.
- Circumareolar or Donut Mastopexy: Repositioning the areola. This has the potential of flattening out the breast. Listen to the details of what Dr. Matatov explains regarding this. It is not his preference for a breast lift.
- Lollipop or vertical breast lift: An incision around the areola and from there a line going down to the fold. He considers this a true breast lift procedure since you are moving the gland as well as the nipple. This helps correct glandular ptosis, or sagging of the breast due to age, pregnancy, and normal changes to the breast tissue over time.
- Wise pattern mastopexy breast reduction or anchor scar.
Patient consideration, size, need for radiation, condition of the skin in terms of laxity are all important clinical evaluations that should take place during a plastic surgery consult for your breast reconstruction surgery. Be sure to ask your surgeon about “predicting” changes to the breast tissue in the setting of radiation. Dr. Matatov thoughtfully covers this in the video using the term “reasonable symmetry”. None of us were born with perfectly symmetrical breasts and it will be this way after reconstruction.
Achieving Symmetry in Breast Reconstruction through Nonsurgical Methods
I found it very fascinating that Dr. Matatov tells us other factors affecting symmetry even before cancer. For instance, if you are right-hand dominant you pectoralis muscle will be more robust, a bulkier, bigger muscle. Your chest wall may be slightly different because of this. He points out these underlying structural changes were there before cancer. However, he sometimes advises patients in this setting to exercise the smaller breast to improve the symmetry that involves no surgery.
He shares this pearl of wisdom because this can be considered an adjunct. This is an additional option to speak to your surgeon about. Why? Because it does not involve surgery. Dr. Matatov tells us to consider this as a global picture, that you are treating the entire individual and not just the breast.
How Fat Grafting Works in Breast Reconstruction
Breast reconstruction is seldom one surgery but more often a staged procedure. Fat grafting is often part of the second phase or stage of breast reconstruction. But what is the mystery behind this “liquid gold” and how it works? Dr. Matatov begins by telling us there is no hard research that tells us one technique for fat grafting works better than the other. He tells us patient expectations are a very important factor once again. This of course, involves having a shared decision-making conversation with your surgeon about fat grafting and what it can achieve for breast symmetry.
He tells patients the first or second week after fat grafting you are going to be pleased. Swelling, the fat that is currently in there, the inflammation due to traumatizing the tissue will all make the breast have more volume at this time. It changes over time and so does patients perception of the fat grafting procedure. Dr. Matatov shares that he often does more than one fat grafting procedure for these reasons and the fact you cannot change a large deformity in only one fat grafting.
In a radiated breast, the fat takes very differently. Radiation by its nature decreases blood flow to the area. Cancer needs a lot of blood source to grow so radiation to the breast decreases this likelihood by decreasing blood flow. The fat grafting still works to radiated tissue just not as well. He used the term “placing small aliquots”, meaning a gentle, slow approach to placing the volume of fat to the tissue. This reduces the frequency of oily or hard cysts. These can become concerning to breast cancer patients as a recurrence when patients feel fat necrosis. These are techniques he has found to set patients up for success during this phase of breast reconstruction.
Patient Instruction for Care Achieving Symmetry and Understanding Fat Grafting in Breast Reconstruction
Leave it be! Dr. Matatov instructs his patients not to disturb the fat that has been injected into the breast. Don’t do anything that moves the breast up and down and don’t apply pressure on them. The idea is to keep them stable so as not to disrupt the blood flow that tries to form. Avoid any force in that area. This is for a period of two weeks. The fat that survives during this period will then stay there permanently. This is like the flap that is placed during breast reconstruction that eventually incorporates into the surrounding tissue.
This fat that stays becomes the “new graft-able bed” that is used for a possible next fat grafting procedure. He explains that more fat cells can be placed the following round because of this new bed that formed from the first fat grafting. Dr. Matatov points out there is no way to predict how much fat will survive because the literature tells us there is a very wide range. This is a same day procedure and patients go home that day. The incisions from the cannula used in fat grafting are tiny and will not require stitches and heal nicely.
The entirety of the video can be viewed here. Dr. Matotov provides a great resource answering questions about “Achieving Symmetry and Understanding Fat Grafting in Breast Reconstruction” and I am grateful for his time and expertise.