Q. I recently completed breast reconstruction on both breasts after bilateral mastectomies for breast cancer. I have breast implants on both sides. I am, for the most part satisfied, however I have a significant dent in the upper part of one of my breasts which is noticeable if I wear a bathing suit. I don’t want to have more surgery if I can help it, so is there anything that can be done for this indentation?

A. Contour irregularities of the breast after breast reconstruction is not uncommon, regardless of the technique used to reconstruct the breast. These deformities can be either an area of hollowness leaving a dent in the breast or an area of excess tissue creating a bulge. In your instance, you are describing an indentation in the upper part of your breast which is likely due to a deficit of fatty tissue in the area. If the area is bothersome to you for any reason, then you should consider correction. Typically, exchanging your implant for a larger implant is not the best answer since the indentation is limited to a small area, and a bigger implant is going to address the entire breast instead of the specific area in question. The best approach to your problem does require surgery, but it is a relatively straightforward procedure with a short recovery. The procedure that I would consider is fat grafting to fill the hollow area. This requires removing some fat from wherever you may have some extra fat (stomach, thighs or love handles are common donor sites). The fat is then prepared by cleaning it and then the fat is injected into the indentation. This will fill the hollowness and improve the overall contour of the breast. You need to be aware that a certain percentage of the fat will be reabsorbed and therefore some of the indentation will likely come back within a few months. You should be prepared that you may need to repeat the fat grafting procedure 2 or maybe even 3 times before the irregularity of the breast is adequately corrected. There are very few risks associated with the fat grafting procedure other than the known probability that some of the fat will be reabsorbed. Other risks include infection, bruising, bleeding in the breast, damage to the implant, creation of a cyst at the injection site and failure to achieve the desired result. I would recommend you return to the plastic surgeon who performed your surgery and ask for their evaluation of the indentation and whether you are a candidate for fat grafting.

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