How Long is the Process of Fat Grafting to Breasts?

As pointed out by several experts in previous posts the Fat Transfer procedure for Breast enlargement of Breast Augmentation takes 2-3 hours.

Some surgeons take longer and justify their time by very careful Fat Transfer injection in small amounts and claim superior results as a result of their technique as is done by Dr Coleman in New York.

Dr's Khouri and Del Vecchio have recently made strides in reducing the time required.

The key is to find an expert who is used to doing Fat Transfer to the Breast, choosing a Plastic Surgeon you are comfortable with and trusting the doctor to use the best technique to achieve your result. Let the doctor worry about the time involved.

There are 3 parts to fat transfer, and the length of time can vary a lot depending on the techniques used.

Part 1)  liposuction of the donor sites.  If small cannulas or syringe liposuction is used - it takes longer.

Part 2) processing the fat.  Centrifuging the fat in small volumes takes longer.

Part 3) injecting the processed fat into the new area.  Using micro-injection techniques takes longer.

Surgeons debate which technique is better.  Some experts, like Dr. Coleman of NYC, feel that the longer way at each step gives the best results.

Most surgeons report that fat grafting to the breast takes between 3-6 hours, depending on the exact methods used.  Dr. DelVecchio of Boston, and Dr. Khouri of Tampa have been making important contributions in trying to reduce the procedure time, but still get good results.

Fat grafting is a growing movement for breast augmentation and reconstruction.  The "typical" breast augmentation case takes around 2 1/2 hours, which includes the liposuction to harvest the fat, the processing of the fat, and the time to inject it.

Time variation? There are many reasons for this.  Is the fat hard to harvest? A skinny woman with little fat may take longer to harvest because you have to work harder to find the fat and harvest enough.  As with everything, when you are newer at doing the procedure (which most doctors are as this technique still is not mainstream) it may take a little longer.  I spent time with Dr. Khouri in Miami (who along with DelVeccio are among the most experienced) who has a team of people who assist him and do it day in and day out- so his times are likely faster.  Also, for some of my patients, they don't mind if I harvest a little extra fat, to maximize the changes from the liposuction portion of the procedure.

Cost? This will vary by surgeon, time, where you live. 

Thank you for your question.  As you can see, there is a dramatic difference in opinions among plastic surgeons on this issue.  You will note that Surgeons who routinely perform this procedure, have great outcomes like Dr. Del Vecchio, and have the background to discuss the science, will tell you that this is the single most important development in breast surgery in the past 10 years.

Fat transfer works well, it has good results, and with comparatively less issues than other breast surgery options, in the right group of patients.  You should consider a consultation with a Surgeon who is experienced with this technique, has performed more than a few cases, and has adequate follow up to discuss outcomes with you.

In terms of the time required for this procedure, Surgeons who are more experienced with the technique will take less time than others who are not.  We usually can perform a fat transfer to the breast in between one and two hours. I would encourage you to look into this option in your area.

Fat Grafting to the breast can be routinely performed by a single surgeon in under two hours.  This is a fact.  See the link below for our  paper published in June, 2011 Plastic and Reconstructive Surgery.  The average volume of breast increase long term was 250cc, or a doubling of breast size.  Patients who have results at 4-6 months have kept their results 4-5 years now.  Fat grafting to the breast can result in mammographic abnormalities , however, these are readily distinguishable from cancer.  The statement "most of the fat goes away"  is simply not true.  I would encourage any of our colleagues who inform patients that fat grafting does not work or is not safe to read the exciting work that is comng out in our specialty's journals.    Although I perform many breast augmentations, I believe implants have their own set of problems.  Where this will settle out is that there will be a subset of women who will prefer natural fat for minor augmentation, and there will always be a need for implant augmentations.  The two are not interchangable, have different aesthetic results, and will appeal to different patient groups.

Dr Daniel Del Vecchio, Boston

bostonbreastcenter.com

The previous expert posters, especially Drs Hartog & Khoobehi, have given you great info. To answer your questions directly in order:

1. Timing can be based upon amounts needed to be harvested and injection citeria. On average 2 to 3 hours per session is a base line. I'm doing one this morning so I believe it will take 3 hours.

2. Cost ranges from $8,000 to $15,000 dependent upon amounts, time in surgery, doctor pricing.

3. Answered in #1

4. S/A

fat grafting is still not widely accepted by plastic surgeons but is becoming more popular:

1. it has been used worldwide a number of yearsa
2. if done correctly at least 60% of the fat should remain as living fat
3. it has been used widely for gluteal augmentation
4. it shouldn't take more than 2-3 hours but it depends on how much liposuction is being done and the cannula technique preferred
5. there is no complete agreement on best technique

There are two components to the fat grafting process; the liposuction harvesting component, and the micrografting injection component. In general the length of the procedure is dictated by the first part, the liposuction part, as the reinjection part is usually fairly quick and dependant only on how much fat is being injected - usually from about 150 - 400cc.

There is still some discussion as to the best way to harvest and process fat prior to injection. On the one hand there is the very slow process of harvesting using small syringes and centrifuging (spinning the fat), which is considered the gold standard by some in terms of fat survival for grafting purposes. Unfortunately this part of the process is very slow, and can extend a breast augmentation with fat procedure to 6 hours or so. On the other hand there are those who claim that the fat can simply be sucked out with regular liposuction, the fluid decanted, and the fat reinjected. Using this approach, there is likely significantly more tissue loss after grafting, but it is fast and can drop the procedure to under two hours. Generally this approach injects significantly more volume of fat and fluid, with the expectation that much of it will absorb. The one published study that uses a modification of this approach, shows about 65% retention of the original volume of fluid and fat that is injected. This same study also utilizes the BRAVA device to expand the tissues prior to injection to increase the fat retention. As in most things, I think the best answer is somewhere in between, so in my practice, most fat augmentation procedures take 2.5-3.5 hours, using the gentlest harvesting techniques that are practical and using the PureGraft fat purification process, and micrografting injection. The one thing that the patient can do to make a difference is to use the BRAVA. Whatever grafting procedure is used, BRAVA can improve the final outcome by allowing more fat to be injected successfuly at one time.

We are also able to harvest fat extra fat to be stored in our  in clinic lipobank so that if repeat procedures for more volume are required, then no further liposuction is required, making the micrografting procedure a 45 minute procedure that can even be done under local anaesthetic.