Fat Transfer Breast Augmentation
Doctor Answers 64
Fat is ideal for breast augmentation
More and more data is accumulating that fat transfer, when properly performed is as safe if not safer than breast implants. With regard to mammography and breast cancer detection, cysts, lumps etc, again the data accumulating is that with good technique these problems can be minimized. With regard to long term breast cancer risk, there is also no data thus far to show increased risk in patients who have had fat grafting. Fat grafting in the breasts now has a track record going back 25 years or more, and actually performed in the 1980's already by the originator of liposuction, Dr. Illouz from France. This last weekend I had a long conversation with him at IFATS, a recognized meeting on fat grafting, regarding his experience. He has performed over 500 of these, and with long term follow up of over 100 of his patients, has not had a single case of breast cancer.
The most important thing to understand is that fat grafting is completely different to implants, in that the exact size increase from a given grafting procedure is not precisely predictable. With good technique approximately 150-200cc increase in volume can be achieved per grafting procedure. For further volume increase, the procedure can be repeated. If the patient is prepared to use the BRAVA® external expansion device prior to grafting, there is good data to show that volume can be increased to 300cc or more per procedure.
I am happy to provide you with numerous references if you wish to contact us. I blog regularly on this subject on my websites
Lipotransfer - Fat transfer to the breast is not the same as breast implants
Breast augmentation with implants will form the breast into a certain look that is specific to implants. Because of the common appreciation for this "look", many women now seek that particular appearance as desirable and attractive.
Other women, who do not wish for a large size change, but prefer a smaller size and shape adjustment without an operated appearance, now have an additional option: transfer their own fat to improve breast shape and increase breast size.
Women who seek a completely natural breast augmentation without the use of implants have a safe, effective option, that will increase breast size and correct breast shape problems including issues caused by breast implants like rippling, thinning, double bubble.
Mammogram changes after lipotransfer are dramatically less than after breast reduction or breast lift (published data) and there is no implant to obscure breast tissue. Moreover, if lipotransfer is recommended for breast reconstruction in women who have had breast cancer, would that not be an equally safe option for women who did not have it? Surgeons including myself who have experience in this procedure report consistent and predictable results of breast size and shape corrections with lipotransfer. Lipotransfer fat transfer is currently extensively used for cosmetic breast treatment in the world (case series exceeding 3000 patients from France) and accepted as an emerging technique in the USA.
There is a large amount of data available in the surgical literature to clarify any questions about mammograms, post procedure follow up and possible consequences of fat transfer, including comparing fat transfer to other breast procedures.
Women who seek the look of a breast implant with fat transfer will not achieve it. Breast implants and lipotransfer do not give the same outcome as these are two very different treatments for patients who have different desires. Fat transfer can be used for a predictable change in breast size and shape with a safe procedure performed in about one hour leading to a soft, pliable, completely natural breast.
Fat transfer is a good technique for the right patient
Just like most procedures we do, fat transfer to the breast is a good option for the right patient. Performed correctly, it can produce satisfactory results and meet the expectations of a certain group of patients. As a pure augmentation technique, that is, a procedure designed to increase the size of the breasts without using implants, its utility has limitations. While it can accomplish this, typically the size increases are in the range of one cup size, or perhaps just a little more. The amount of fat that lives, and thus lasting increase in size, depends upon a number of factors. First, the way in which the fat is harvested is very important, and this can have a significant influence on how many fat cells go on to survive permanently. There are a number of methods that can be used to harvest fat for transfer, and some are better than others for preserving the viability of the fat. Second, after harvest, the way that the fat is prepared as a graft is crucial in determining how much of the transferred fat will live. Again, there are many ways that the fat can be prepared for grafting, and again, some have been shown to be better than others. Lastly, how the fat is actually transferred is very important to determining not only fat survival, but also aesthetic shape and proportion of the breast. This is very much dependent upon the skill and judgment of the surgeon performing the procedure. These considerations are reasons why it is important to select a surgeon with proper training and experience in fat transfer.
One other thing to consider about fat transfer, is that it can offer a very nice adjunct to traditional breast augmentation with implants in those cases which a woman has very thin tissue and little camouflage for implants. In these situations, fat may be transferred on top of around an implant in order to soften its contour and produce a more natural looking and feeling breast.
Regarding the issues of safety, a number of studies have come out now addressing this issue, and at the present time, there does not appear to be any literature that conclusively shows that fat transfer to the breast poses any significant danger to patients; in fact, most studies now are showing the opposite. This includes mammography studies which, report that findings consistent with fat transfer can be seen on mammograms, however, they are easily distinguished from findings suggesting breast cancer.
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Fat transfer for breast augmentation: it works but should you choose that option
Fat transfer for breast augmentation works but there are three main issues that you should consider before deciding to go forward:
1) Since there is not yet an agreement about mammography among radiologists regarding fat transfer in the breast would you be comfortable with the idea that there might be some question about the mammagraphy results down the road?
2) Fat grafting breast augmentation is often more expensive than traditional implant augmentation since more work is involved.
3) There is a limit on how much in cup size increase that can be achieved in one fat grafting session. Usually one cup size increase is what can often be accomplished in one setting with fat grafting.
All the best,
Fat Transfer to breasts is a bad idea
We have been hearing more and more about this. The results are usually moderate, (one cup size). Historically, fat has been tried to augment the breast. The problem is that it there are an large percentage of untoward events, (cysts, fat necrosis, lumps, etc.). Most importantly fat will often calcify in the breast. Calcifications on mammogram are cancer until proven otherwise. In the past women have received biopsies or worse that they did not need to have. Up until recently the plastic surgery societies, (ASPS and ASAPS), did not want their membership to do these procedures. They still don't, but they do state that there are some controlled studies ongoing. We will see the data as it comes back.
In light of the fact that 1 out of 8 women get breast cancer, as of this writing I would not put fat into the breast. If you want to enlarge your breasts, I would go with an implant.
Breast Augmentation using your own fat- Be careful.
As you can see by the number of responses to this question, it's a 'hot topic' in Plastic Surgery. Just like the more common procedure where your own fat is transferred to the buttocks, we have learned that 'fat transfer' is a successful procedure when performed properly. However, there are concerns regarding the breast that don't really exist anywhere else on the body- most importantly the fact that cancer in the breast is not uncommon and we don't yet know how fat transfer to the breast will eventually effect a breast that is destined to get breast cancer. Will the risk of breast cancer change? Will the ability to detect breast cancer change? These are two of the critical questions that don't yet have answers. There is enough concern about these issues that I will not yet perform this procedure in my practice.
New procedures and devices are developed all the time. When there's a good procedure or technique available then most of us will incorporate this into our practices. When something is new or evolving- as is the concept of fat transfer for breast augmentation- there will always be those surgeons who 'jump on the bandwagon' thinking that, in offering something that other surgeons don't yet offer, they appear 'better' in the marketplace. At this point I would caution this philosophy with fat transfer for breast augmentation. It is a technique that is showing some promise. How much promise, and with what exact risks and benefits, remains to be seen.
Breast Augmentation with Fat Injection and Fat Grafts
Breast augmentation with fat transfer is currently under much research and debate in the United States and abroad.
For years, the American Society of Plastic Surgeons had cautioned its members against performing breast augmentation with fat injections because of fears that the injected fat could interfere with mammograms, inhibit future breast cancer detection, and possibly stimulate breast cancer development.
Recently, after finding a lack of scientific data to support those fears, the American Society of Plastic Surgeons revised its stance on breast augmentation with fat injections, saying its members could proceed with caution.
Pros of Breast Augmentation with Fat Injection:
1. No need for breast implant
2. Simultaneous liposuction of fat from an area of excess body fat
Cons of Breast Augmentation with Fat Injection:
1. Can achieve only about 1/2 to 1 cup increase in breast volume
2. Approximately 60-70% of injected fat will not survive
3. May require more than one operation to achieve desired size
4. Does not change the shape of breast, nipple position, or sagging
5. VERY technique-dependent and MUST be performed by an experienced surgeon
So, to answer your question, for the right patient who wants a very minimal increase in size and has realistic expectations, breast augmentation with fat injections is probably a safe alternative to breast implants.
Jaime Perez, M.D.
Breast Augmentation Specialist in Tampa, Florida
Plastic Surgery Center of Tampa, Florida
Fat injection for breast augmentation produces a different look than implants
Fat injection is probably safe for breast augmentation, but there are theoretical risks for interfering with mammography and breast cancer detection in general, which is important since breast cancer is common. Some scientists have also expressed concern that the fat cells could increase cancer rates. Another consideration is that fat survival is unpredictable, so fat injection may have to be repeated. Perhaps most importantly, patients should consider that breast enlargement with fat transfer produces a different 'look,' or appearance, than implants. Implants will tend to give a larger, fuller, higher breast. Fat injection will generally produce less fullness and a more subtle enlargement. Get more than one opinion before proceeding. Hope this helps.
Fat Transfer to Breasts
The techniques for fat grafting to the breast are promising, but still developing.
I would not recommend fat grafting for breast augmentation unless you fully understand the risks and trade-offs, including unreliability of volume, possible asymmetry, risk of cyst formation, proper preparation and possibility of further surgery.
For most women (and their surgeons) it is not yet a practical alternative to breast implant augmentation.
FAT GRAFTING WORKS FOR BREAST AUGMENTATION - GAINING MORE ACCEPTANCE
This still is a controversial topic in plastic surgery, as no official regulating body is willing to endorse the procedure at the moment.
As a board certified plastic surgeon who practices this technique,
I believe that the procedure can be carried out very safely, but as to the long term effects of fat grafting on breast tissue - we do not know all the answers.
Some of the potential complications regarding fat transfer to the breast are:
- inflammatory reactions
- fatty oil cysts
- irregularities &
- Calcium formation.
Part of the controversy lies in:
- false positive mammograms for detecting cancer in patients who have this technique, because of the calcium formation. Experienced radiologists are able to detect the difference,
- and the unknown effect fat grafts have on normal breast tissue in relation to breast cancer development.
Dr. Carlos Cordoba
MDCM, CSPQ, FRCS, FACS
Plastic & Esthetic Surgeon
4055 Ste-Catherine O. Suite 100
Montreal, QC. Canada H3Z 3J8
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.