Where Does the Fat Go if It Doesn't Survive the Graft to Breasts? Does the Number of Cc's Really Matter for Size Increase?
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Fat Transfer to the Breast
Fat transfer to the breast is an exciting but still somewhat controversial new area in Plastic Surgery. Fat is harvested from an area where you dont want it such as the abdomen, flanks or thighs, processed, and re-injected in an area that is deficient such as the face, buttocks or breasts. Fat is usually injected in small droplets to increase the chances of the graft surviving by being perfused by blood and oxygen from surrounding blood vessels and tissues If large amounts or globules are injected, the chances of fat necrosis or death increases because oxygen and blood cannot get to the fat. The fat that dies is usally absorbed by the lymphatic system, but some of it may for a hard lump referred to as fat necrosis. This lump can also become calcified. This is not a major issue if injected in the body, but becomes significant in the breast. Mammography helps us to detect breast cancer by screening for calcifications and lumps. Large amounts of fat necrosis may confound interpretation. While this is only a theoretical concern, given the role of breast cancer in our society most surgeons are cautious about injecting too much fat at once. The Brava Bra has helped to improve vascularity, space and survival of transferred fat to the breast. It is cumbersome but effective. Hope this explanation helps. All the best.
Natural Breast Augmentations
The results are difficult to predict because "fat take" (the amount of fat which survives after being transferred) can vary anywhere from 20 to 80%. The success depends on several factors. It is like trying to predict how many seeds will sprout when you plant them in the ground.
Fat must be obtained from a donor site and therefore satisfactory quantity and quality of fat must be available. The procedure requires an anesthetic and may be performed in the office or surgicenter. On average, 50% of the injected fat will be absorbed but the fat which remains is permanent. Several operative sessions may be required to achieve the desired result.
200 cc per breast at a time
In general, 200 cc per breast is typically the upper limit of injection recommended by most. It is not that more cannot be injected, but on average this has been determined to be the most that can be expected to live during one transfer. The fat must be injected through multiple planes in small amount passes. Most surgeons will perform more than one procedure for greater augmentations. Kenneth Hughes, MD Los Angeles, CA
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Fat transfer for breast augmentation
The fat that doesn't survive a fat transplant simply gets reabsorbed and metabolized.
A small breast will only accept a certain amount of fat since each strand or droplet needs to touch a normal piece of breast to grow a blood supply. The fat is woven in strands or droplets into the breast and is a true transplantation of tissue the same way that a skin graft is. Not all of the fat survives the transplant so some will be reabsorbed. A bigger breast can accept a bigger volume than a smaller breast can. I hope that helps you understand a little better the limitations of the procedure.
Fat Transfer to breast expectations
The advantages of fat transfer is that you get a completely natural feeling enhancement that looks like a normal breast. The down side is that the amount of augmentation is variable. How much fat a breast can take is uncertain but at a point fat is being injected and the pressure is increasing and survival is decreasing. A large skin envelope can take more fat and this can be modified in tighter skin with Brava expansion. We typically find that about 300cc in most breasts is all that really fits.
We have also done studies that shows processing techniques affect the volume achieved. We found that centrifuge processing had about a 30% take while processing the fat with Puregraft had about 50% take.
Limitations on fat grafting to breasts
Although fat grafting techniques have improved, there are certain limitations. One of the reasons it was not done for many years is because fat cells that don't survive can leave lumps, cycts, and specks called calcifications on mammograms. In order for the fat cells to survive each clump of cells has to be surrounded by healthy tissue to deliver oxygen. It seems that about 150-200 cc's is the most that can be reliably done for most breasts.
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