Fat transfer to dense breasts - Would this be a good idea?

Question

Hi, I have very dense breasts and have to have mammograms and sonograms every 6 months. Would fat transfer to the breasts not be a good idea for me? Could it make it harder to see changes with new fat added? Could it make my breasts even more dense?

Daniel Barrett, MD · Answer

Dear Questionqueen76,
fat transfer breast augmentation is a viable alternative for women who desire larger breasts without the use of implants. Fat transfer is also widely used in reconstruction of the breast after a mastectomy or lumpectomy. It can also be very effective in correcting the size and shape of the breasts due to genetic problems such as tuberous breast or Poland Syndrome, two conditions that look like misshapen or underdeveloped breasts.In addition, the following scenarios are also reason to consider breast fat grafting:• If you have chest areas that appear creased and sunken• If you desire more permanent correction than is provided by temporary fillers• If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate the natural curve of your breasts• To fill in contour irregularities or hide obvious signs of breast implantsYou should discuss your concerns with a board certified plastic surgeon and make sure your surgeon understands your concerns and your breast augmentation goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Alan Gonzalez, MD, FACS · Answer

Hello @Questionqueen76, thank you for your question. Fat transfer the breasts is a two-in-one procedure that combines liposuction and fat grafting. The procedure adds volume and contour to the breasts by transferring fat cells from other areas of your body such as the abdomen, thighs, or buttocks. While it's not possible for anyone to predict with certainty how this procedure will affect future mammograms and sonograms due to individual anatomical differences, many studies have shown that fat transfer does not increase breast density on imaging scans. Fat grafting can be done safely with ultrasound-guided cannulas in order to provide consistent results while avoiding any potential damage to underlying structures like nerves or blood vessels.   For more information and recommendations consult one or more board-certified plastic surgeons. . Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Jeffrey Lisiecki, MD · Answer

Dense breasts are not necessarily a contraindication for fat transfer to the breasts.  The bigger questions would be why you need imaging so frequently and what they are monitoring for, and then likely a conversation between your plastic surgeon and OB-GYN (or whoever is monitoring your breast health).  Fat transfer to the breasts creates fewer imaging changes than a breast reduction does, and we do breast reductions in people with dense breasts all the time.  If anything, fat transfer should make your breasts less dense because fat is less dense than glandular tissue.

Zoran Potparic, MD · Answer

In order to avoid difficulties of reading and misinterpretation with follow up mammograms, fat is injected into the muscle and subcutaneous tissue of the breast. Insignificant amount may be injected into breast tissue itself, unintentionally. Hope this helps.

Connie Hiers, MD, FACS · Answer

Fat can be added, but is harder in dense breasts. As you age, your breast will become less dense naturally.

Mats Hagstrom, MD (license on probation) · Answer

Breast fat transfer is two procedures done at the same time. The two procedures are liposuction, followed by fat grafting. The ideal candidate for breast fat transfer should be a good candidate for Liposuction and a good candidate for breast fat transfer.
Understanding your own candidacy for the procedure is fairly involved in complex, and requires in person consultations with sufficiently skilled and experienced plastic surgeons who have mastered this procedure.
Furman breast, tissue or fibercystic type breast tissue an exam or as identified on mammogram, is technically slightly more difficult to graft than women who have softer fattier breast tissue.When grafting fat in the breast, we try to stratify the grafting through as many layers as possible in order to spread out, grafted fat so that ideally, each particle of grafted fat is surrounded by live vascular tissue. This helps increase the graft survival.
Firm breast tissue does not take to fat grafting well or even at all. This limits the amount of fat that can be grafted to some degree. It’s possible to have dense breast tissue, but still have a nice supple subcutaneous fat layer that can be used for grafting so while it’s not ideal, it doesn’t make the procedure contraindicated.
It might reduce the amount of fat that can be successfully grafted in a single session, but so do many other variables.
Doing these procedures, well, on a consistent basis, with the ability to deliver predictable outcomes, is more difficult than most people believe.
Breast fat transfer can consistently increase breast volume by 1/2 cup when done correctly by an experienced provider on a typical patient. Fat transfer is not good for changing the shape of the breast and patients should have a clear understanding of what they’re trying to achieve as well as what the procedure can, and cannot accomplish. A lot of women believe that increasing breast size also changes breast shape, but this tends to not happen from this procedure.
It’s important to have a clear understanding of what you dislike about your breast or perhaps what changes you would like to have happen. Many women seek fat transfer, hoping that this procedure will increase the volume in the upper half of the breast. Fat transfer is not particularly good at doing this. Implants on the other hand, specifically given volume in the upper half of the breast an implant augmentation unlike fat transfer has a market Improvement in breast shape, giving better projection and far more volume in the upper half of the breast. 
Fat transfer results even one done well by experienced providers, gives subtle results that only increase breast volume but does not significantly change breast shape.
Women who are looking for a more dramatic change, or wish to have a change in the shape of their breast, should consider other more appropriate procedures.
Well, some patients are not seeking to have liposuction Liposuction is still part of the procedure. The ideal candidate should get benefits from both Liposuction and fat transfer.
I doing these procedures well both Liposuction and fat transfer is not easy 
If done poorly these procedures can leave people with undesirable outcome, including disfigurement.
The number of plastic surgeons who have truly mastered both Liposuction and fat transfer is relatively few and patience should be very selective when it comes to choosing providers for both Liposuction and fat to transfer. In my opinion, patients should probably be far more selective than they ever thought necessary. Being board-certified and plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered either Liposuction or fat transfer. There are a significant number of plastic surgeons who are simply not good at Liposuction or don’t like performing the procedure.
To minimize having a negative experience and maximizing quality outcomes, I recommend patients interested in having breast fat transfer have multiple in person consultations. There’s no correct number of consultations to find the right provider but I suggest patients start by having at least five in person consultations before scheduling surgery.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body and breast characteristics that you do. An experience provider should have no difficulty showing you before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a provider’s career is completely insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures any one surgeon has actually done. Breast fat transfer is also unique in that early. Postoperative results can look very impressive, but does not resemble final results by any stretch of the imagination. Early postoperative pictures can easily make a woman with big cup breasts have full see or even D cup breasts. The majority of this volume will dissipate over the next few months after the procedure. Results do not begin to represent final results until 3 to 6 months after the procedure. do not assume before, and after pictures were taken as long-term follow up in pictures ever. Always confirming the exact timeframe of when after pictures were taken in relationship to the date of surgery when reviewing before and after pictures during a consultation. if pictures look very impressive, then you should always ask yourself if these may represent early results, which are not representative a final results.
Understanding your own candidacy for both Liposuction and fat transfer, and finding the most talented and experience provider are the two single most important variables, and when things don’t go well, it is almost always, because of failure of patience to have a clear understanding of one of those variables. 
In my opinion, patients do not spend enough time properly vetting plastic surgeons, and taking the vetting process seriously.Never assume somebody can do this procedure well until you’ve seen sufficient quantity and quality of before and after pictures to show a consistent track record of quality work.
When, in doubt, slow down and schedule more consultations.
 Breast fat transfer does change mammogram readings. To my understanding radiologist are not missing breast cancers, because women are having fat transfer. The procedure will, however, change the appearance of breast tissue on mammograms.
Best,
Mats Hagstrom, MD

Fat transfer to dense breasts - Would this be a good idea?

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