October 17, 2017

Innovation: Breast reconstruction through fat grafting

Kaiser Permanente plastic surgeon uses minimally invasive surgery with natural materials from a patient’s body. The result? Faster recovery and less scarring and muscle damage.

“I would do anything to avoid getting cancer — anything.”

That’s how Sarah, a Kaiser Permanente member, steadfastly explains her response to learning that she has a mutation in her BRCA2 gene — putting her at increased risk for breast and ovarian cancers.

The 42-year-old married mother of two from Vancouver, Washington, put a lot of thought, prayer and research over the past couple of years into her decision to have a preventive double mastectomy, followed by breast reconstruction using fat from her own body.

One of the few in the world

Since 2015, Jennifer Murphy, MD, a board-certified plastic surgeon and chief of plastic surgery at Kaiser Permanente Northwest, has been one of the few plastic surgeons in the world to innovate the use of fat-grafting techniques for total breast reconstruction.


photo of Jennifer Murphy, MD Jennifer Murphy, MD


Before Sarah’s double mastectomy, she and Dr. Murphy discussed treatment options, including fat grafting versus silicone implants. Fat grafting won out because of its use of natural material from her body, and the associated benefits from minimally invasive surgery — such as faster recovery, less scarring and no muscle damage. “I chose the path that was right for my body,” says Sarah.

“I knew that fat grafting for total breast reconstruction is performed by just a handful of plastic surgeons, so I was delighted to discover that Dr. Murphy offers this option.”

What is fat grafting?

Fat grafting involves removing fat from the thighs, abdomen and buttocks and using it to create additional volume in the breast. For total breast reconstruction, Dr. Murphy builds up the foundation of the breast a little bit at a time. Most patients require one to three surgeries over the course of a year or more.

In Sarah’s case, Dr. Murphy worked closely with fellow surgeon Christopher Moran, MD, who performed Sarah’s mastectomy. After removal of her breasts, Dr. Murphy implanted fat from Sarah’s abdomen into the site. In addition, thanks to a procedure performed by Dr. Moran, Sarah’s nipples are intact and have retained slight sensation. Patients who don’t receive the nipple preservation step typically receive a referral to an outside tattoo artist who specializes in creating 3D-appearing nipples for plastic surgery patients.

“Both surgeons and their teams did a fabulous job,” says Sarah. “Dr. Murphy was amazing to work with. Her communication style is forthright, with no false expectations.”

Sarah has two or three more fat transfers yet to go. She received confirmation that “things are looking good” when a nurse who was helping her dress was “stunned to find out that I had had a double mastectomy.”

Sarah’s elation is matched by other patients who have also had the procedure.

“After a lot of research, I chose fat grafting because it seemed like the best choice for me even though it was not a quick process,” says Joyce, another Kaiser Permanente patient. “I cannot begin to tell you how excited I was when I was all finished because not only do my breasts look fantastic, they also feel very natural.”

A passion for helping patients

Dr. Murphy says that total breast reconstruction helps women to feel normal after having had a mastectomy. She has a passion for helping patients erase the visual reminder of the trauma their bodies endured in response to a cancer diagnosis, or in Sarah’s and Joyce’s cases, a genetic likelihood of a cancer diagnosis. “I find joy in helping them conquer their disease.”

“Grateful” is the word Sarah uses to describe her current state, adding, “I am so lucky to be in a time and place to learn about the latest treatments — and to access them right here, in my own community, from Kaiser Permanente.”

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