How can I increase the chances that fat transfered to my breast will stay and not be dissolved?
Doctor Answers 4
How to increase fat graft survival in breast augmentation. And other important questions you didn't ask.
(How is that done, BTW?) Protein or fat is not deposited in newly grafted breasts.
When fat grafting is done for breast augmentation, the scar tissue and calcium deposits make mammography more difficult to detect cancers in their early stages, which show up like small dense scars or microcalcifications. To be fair, most radiologists will state that they can tell the difference between microcalcifications from dead fat grafts and microcalcifications from fat killed by cancer cells. I remain unconvinced that dead fat looks different from dead fat by another mechanism in all cases. Maybe SOME, but not all!
But that's not really important either--it's YOUR life and possible delayed or missed diagnosis from breast cancer that could be obscured by elective fat graft breast augmentation. Since 11-12% of women will develop breast cancer in their lifetime, it's a pretty big bet someone is making with their patient's life when they put fat in a normal breast to enlarge it, rather than using implants below the muscle, which have been exhaustively proven to have NO influence on the development or mammographic detection of breast cancer.
BTW, I have absolutely no problem with fat grafting for facial volume, improvement after liposuction dents, or the like, and I believe fat grafting can be a fabulous way of reconstructing breasts or enlarging reconstructive flaps after mastectomy. But not in a normal breast that needs lifetime examination, mammography (until something better is developed), and hopefully early detection of the cancers over 11% of women WILL develop.
So, it's not that grafting fat is bad--in fact, it's great--just NOT IN A NORMAL BREAST for elective augmentation. We have a better and safer alternative--breast implants.
BTW, since the dead fat causing scar and calcifications is the cornerstone upon which I base my whole discussion above, there are surgeons who claim up to 100% fat graft "take," perhaps to sound like they are the "expert" in fat grafting, or perhaps to deflect the concerns about dead fat causing scar densities and microcalcifications. Most honest surgeons will tell you that no more than 50-60% or so of the grafted fat will survive; the survival percentage number gets higher the more the doctors think of themselves, or the more they want to "market" their "superiority" (just ask them!), or the more they want to avoid telling you that it takes more than one operation to yield any volume that survives long-term. That's one reason Brava seems to be a big "seller!"
No one really wants to explain to you that fat grafting for breast enlargement not only costs more, takes more time, and won't all survive, but that it also takes a second session! You can't simply inject hundreds of cc's of fat and expect it to all have adequate circulation and oxygenation. It takes tiny grafts surrounded by living tissue for the grafts to remain viable, and this takes lots of time, skill, placement expertise, and a lot of recipient tissue to support all of the grafts. Oh wait, that's the reason we're grafting in the first place--the recipient areas (breasts) aren't very large; that's why the patient is asking for enlargement! So injecting larger volumes of fat looks good at first, right up until the dead fat cells start to be reabsorbed and carried away by your body. This takes time, and occurs slowly enough that the unscrupulous doctors usually have time to move on to other unsuspecting, hopeful, and perhaps gullible patients who feel that "natural" just HAS to be better than implants.
And I will continue to preach this right up until the lawsuits for "missed" breast cancers or "delayed cancer diagnoses" leading to untimely deaths finally expose this practice for what it is--potentially deadly and dangerous for women with normal breasts who have been deceived into thinking that fat grafts are natural and better than implants. BTW, I know implants aren't "perfect" either. But over 50 years of use have made them the most studied and safest medical products in the marketplace, and in the human body!
AS for Brava, this is a cumbersome and time-consuming suction cup device that failed to enlarge breasts more than about half a cup size with weeks of use 8-10 hours DAILY! So, every surgeon who fell for the Brava system, found it didn't "work," is now using it to "enhance their graft take." Wait, aren't these the same doctors who are claiming 70, 80, 90% and more graft "take?" Why do they need to increase their "take?" Must be their superior technique, or maybe it's the Brava use! Is your surgeon letting you use the Brava for free? I didn't think so.
If Brava really worked, then there would be similar interest in suction devices for penis enlargement. Oh, darn, they exist as well! Both are on the fringes of pseudoscience. Others would simply call both of these devices good old-fashioned horse-hockey.
But do they work? If you really think so, I've got this great Popeil "pocket surgeon" that slices, dices, and makes great julienne fries. If you buy it right now, I can add a free "Pathomatic" for instant diagnosis. Please, spare me.
Sorry; I know it was a serious question, but I truly believe you have failed to ask other appropriate questions:
Does fat grafting present any potentially serious risks to my health and life? Can a radiologist guarantee me that his/her diagnosis will be as safe in a fat-grafted breast mammogram as in a non-grafted breast mammogram, or a submuscular implant-augmented breast mammogram? Is fat grafting better than breast implants? Do we really know the long-term on breast fat grafting? (We have 50+ years of experience with implants, and the present implants are the best and safest thus far.)
You should exercise, eat properly in amounts your body needs to stay slim, say NO to Brava, and definitely say NO to breast fat grafting. If you were my wife or daughter that is what I'd tell you! Best wishes! Dr. Tholen
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How can I increase the chances that fat transferred to my breast will stay and not be dissolved?
Kenneth Hughes, MD
Los Angeles, CA