For some patients, the radiation that follows lumpectomy leaves behind a stiff, scarred, and painful breast.
Dr. Richard Baynosa is a tenured professor and founding chair of the Department of Plastic and Reconstructive Surgery at the Kirk Kerkorian School of Medicine at UNLV. He presented ‘The botched breast after breast conservation: fat grafting and adipose-derived stem cells after lumpectomy and radiation treatment—restoring biology, not just volume’ at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS). The meeting was held October 15 to 18, 2026, in Houston, Texas. His talk was part of the panel ‘The botched breast.’ He explained why radiation damage calls for a staged, biology-first approach to fat grafting.
Radiation starves the tissue of oxygen and turns it fibrotic, leaving tethered scars, pain, and a collapsed contour. Fat grafts historically struggled to survive there, and implants are poorly tolerated. ‘We've cured the cancer, but we've created a biological wound,’ he said.
‘It's not really just a volume deficit that we're seeing. We're also seeing a biologic deficit,’ Dr. Baynosa said. Fat contains adipose-derived stem cells, which help repair damaged tissue mainly through the signals they release. ‘We have to really truly think of fat grafting as a cell therapy that we are delivering as plastic surgeons surgically,’ he said.
A Staged Fat Grafting Approach Treats the Irradiated Breast's Biology Before Its Volume
The first session treats the biology, bringing in blood supply, softening fibrosis, and releasing tight scars to ease pain. Trying to restore all the volume at once risks large areas of fat necrosis. Volume comes in 1 or 2 later sessions, followed by a symmetry procedure on the other breast, and each round works better because the tissue has become more receptive.
‘Unfortunately, at least in the U.S., we have significant regulatory constraints with the FDA, and that's not actually allowed,’ he said of growing more stem cells in culture. The literature has not shown that more cells mean better results. His alternative, which he called the ‘secret sauce,’ is to neutralize the pH of the tumescent solution. His laboratory found that lidocaine lowers stem cell viability, and that removing it or buffering the solution to a physiologic pH improved viability with little added cost or time.
Fat Grafting After Breast-Conserving Therapy Shows Reassuring Oncologic Safety Data
Fat grafting changes breast imaging, and about 10% of patients undergo biopsy. Dr. Baynosa cited a paper out of Michigan showing that lipofilling changes the imaging without necessarily changing cancer risk, and most biopsies are benign. Across the studies he reviewed, fat grafting did not raise local recurrence. ‘The problem is we still don't have level one randomized oncologic trials, and the long-term biology is still under study,’ he said.
He described fat grafting after breast-conserving therapy as perhaps the first widely adopted regenerative surgery. The open question, he concluded, is how far surgeons can take the result.