I had silicone breast implants that encapsulated. i then had the scar tissue removed and reinserted breast implant. My implants encapsulated again. i have been going to various doctors for a consults on breast lift and implant. I am more interested in my breast being fuller which becomes a problem with an A cup. Two doctors are steering me to the fat injection augmentation. Is this a reliable method? Another doctor said that I should try the implant again. What would you recommend?
Fat Injection or Implants for Breast Augmentation?
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Doctor Answers 11
Fat transfer for breast augmentation
Hello and thank you for the question.
As several of my colleagues have eluded to, fat transfer as an alternative to traditional breast augmentation remains in its experimental stages, as there are legitimate concerns with its use, and notably the fact that introducing fat into the breast may obscure future radiologic readings and hence potentially delay the diagnosis of an undetected breast cancer. The American Society of Plastic Surgery comments on this in their position paper, Clinical Analyses of Clustered Microcalcifications after Autologous Fat Injection for Breast Augmentation (Plastic & Reconstructive Surgery, 23 December 2010).
While fat transfer is used more readily in reconstruction cases, and with sound reason, further investigations need to be conducted before this procedure is formally accepted into our society as an aesthetic alternative to breast augmentation with implants.
So where does that leave you ? Unfortunately, for women who fall into the course of a recurrent capsular contracture track, options are limited, but they do include performing capsulectomies on mature capsules with replacement of implants into a new tissue plane. The alternative is, of course, explantation, which isn't an acceptable alternative with many women.
Best of luck,
Glenn Vallecillos, M.D., F.A.C.S.
Breast augmentation with Fat grafting
Yes fat grafting is a reliable method to obtain breast augmentation. Your circumstances make you an excellent candidate for removal of implants and fat grafting. While many surgeons often were reluctant to perform fat grafting for breast augmentation because of fear in causing changes on mammograms. However, the changes that occur after fat grafting can be distinguished from those caused by breast cancer.
Patients like yourself, ones with repeated complications due to implants, are often reluctant to have implants placed again and fat grafting offers a reliable alternative. Realize that fat is a living material and is best used to provide a modest change in cup size (1-2 cups larger). Additionally, because some of the fat that is injected will reabsorb you may need more than one procedure to achieve your goal size.
I hope this helps
Fat Grafting for Breast Augmentation
I am sorry to hear of your continued problems with capsular contracture. The only concern I have with fat grafting the breast in elective cosmetic surgery is that the grafted tissue can mimic breast cancer calcifications on mammogram. This can lead to much unnecessary anxiety for the patient and surgeon.
I think fat grafting is an excellent tool in breast reconstruction after mastectomy, but I am still hesitant to use it in cosmetic surgery patients. I will make my decision to offer this to cosmetic surgery patients based on further studies in the literature and recommendation from the American Society of Plastic Surgeons.
In the meantime, I recommend that you undergo capsulectomy with implant exchange and alloderm placement.
All the best.
Paul S. Gill, M.D.
Gill Plastic Surgery
Houston Double Board Certified Plastic Surgeon
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Fat grafing for breast augmentation
The fat is aspirated from the abdomen or thighs using a syringe method or modified suction technique. The fat is typically purified and then transferred to smaller syringes where it is injected into the desired areas.
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 anesthestic 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.
Many experts believe that the best results are obtained by external expansion of the breast skin in order to enhance the blood supply of the breast and render it more soft and supple to more easily receive the grafted fat. This is commonly achieved using a breast pump device that is worn at least 10 hours a day for up to 4 weeks prior and after each fat injection session. Although the grafting can be performed without this pump, the results are not likely to be as successful and it is considered essential to optimize the outcome.
Risks can occur regardless of surgeon or technique. These include but are not limited to: infection, hematoma, discomfort, asymmetry, undesirable effect on associated muscles, overcorrection, undercorrection, pain, prolonged swelling, dimpling, fat necrosis, fibrosis, cyst or abscess formation, nodularity, interference with nursing and aging, alteration in shape with nursing and aging, interference with surgical, oncologic, mammographic, or imaging of the breast, adverse medication reaction, allergic reaction, need for additional "touch up" injections, palpability, visibility, distortion with muscular contraction, need for secondary revisions, and inability to guarantee a specific cosmetic result.
The use of fat injection is another option
The use of fat grafting is another option for the breast enlargement. In your case the problem is the capsular contracture. I have done more than 40 patients that are implant failure patients. They had their implants removed and fat grafting is used to replace implant. The limiting factor is the size of the desired breast size . For the patients with silicone implants ,i would remove the implant and perform fat grafting in a later date. I have an ongoing study listed at
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Breast augmentation or fat grafting
You have not stated what size implant you have at the current time. This makes an enormous difference. If you have quite large implants it would be difficult to make up the difference with fat. Fat grating for a lot of volume is quite time consuming in the operating room and you may not have enough to donate. I would still consider another implant surgery,.It is possible to revise implants and get good results if the procedure is done with meticulous technique and then postoperative treatment with various medications such as Singulair and combined with cold laser treatment. I would get some more consultations with respect to implant exchange
Fat grafting or breast implants?
As the other physicians suggested, fat grafting is really still in its infancy and while there may be many doctors performing the procedure, there are few that are really doing it well. I would recommend using silicone implants again but this time also using an acellular dermal matrix such as Strattice. This graft is placed between the implant and the capsule and has been shown to potentially reduce the risk for recurrent capsular contracture.
I hope this helps!
Fat Injection for Breast Augmentation May Be Dangerous
While fat injection as an adjunct to various breast RECONSTRUCTION methods has gained relatively wide acceptance, the use of fat injection for COSMETIC AUGMENTATION is controversial at this time-some may even say experimental.
According to the American Society of Plastic Surgeons, "Concerns have been expressed regarding the potential that fat grafting to the breast may disrupt or delay diagnosis of breast cancer." This view is clearly expressed in the ASPS position paper, "Fat Transfer/Fat Graft and Fat Injection ASPS Guiding Principles" available on the society's website. One of many potential problems with using fat injection for breast augmentation is the possibility that the injected fat can mimic cancer cells on mammograms. (see: "Clinical Analyses of Clustered Microcalcifications after Autologous Fat Injection for Breast Augmentation" Plastic & Reconstructive Surgery, 23 December 2010. doi: 10.1097/PRS.0b013e318208d1e4). This can cause confusion, lead to unnecessary anxiety and surgical biopsies.
There is further concern that, since fat is one of the organs in the body that produces estrogen, and estrogen is a known stimulator of certain forms of breast cancer, injection of fat into the breast may potentially contribute to the development of breast cancer in some women. Along similar lines, the injection of adipocyte derived stem cells along with fat may be even more dangerous.
Before proceeding with augmentation, be sure to learn about the potential risks and benefits. The FDA has a lot of excellent information on its website which you can find by searching for "FDA and breast implant consumer information".
Hope this helps.
Fat injection vs implants
Fat injection to augment the chest in my mind is still experimental. There are few studies on this in the literature most of which are on correcting contout deformities after breast reconstruction. Most patients desire breast volumes far in excess of what a fat injection procedure would offer.
Fat grafting for breast augmentation
Fat grafting for breast augmentation is certainly being evaluated as an option in a select group of patients. Sometimes going with smaller implants and using something called Alloderm will help to diminish the need for using fat grafting. Remember that fat grafting is not a time tested technique for breast augmentation as of yet. Good luck.
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