There are a lot of factors that must be considered when deciding to use fat transfer to augment the breasts.What size are the breasts now and how tight is the skin? This will help determine how much fat they can hold. If the skin envelope is too tight, this will limit how much can go in.Can the BRAVA help? Yes it can, but... you have to get the BRAVA, and you have to use it. This means wearing it for several weeks before and after the procedure and being religious about it. It is not FDA approved in the United States for this use but many surgeons who do fat transfer breast augmentations will use it off-label to expand the breast envelope. The American Society of Plastic Surgeons have not commented on it as far as I know.How much bigger do you want to be? Going up one cup size with fat transfer is achievable, two cup sizes is possible but sometimes may take multiple sessions, three cup sizes may be unreasonable and you should probably consider breast implants.How much fat do you have? The more you have, the more you can transfer. Everyone thinks they have enough fat but this goes back to "how much bigger do you want to be?" Do you have enough to get there and even more...you should expect your body to absorb 30-50% of the fat transferred. That means the surgeon will have to overfill if possible to get to the desired end point.What's the best technology for liposuction and fat harvesting? Technology actually isn't as important as the surgeon. Great results have been achieved with power-assisted lipo (PAL), ultrasound-assisted lipo (UAL, Vaser, Lysonix), and hydro-assisted lipo (Water-Jet). Laser-assisted lipo (Smartlipo) is probably not a good idea in this setting. Poor results also have been achieved using all these. Surgeon experience and technique trumps them all. Find someone who does this and is confident doing so.Where does the fat go? It goes in the breast, behind the breast, in the muscle and sometimes behind the muscle. How will this affect future mammograms? After fat grafting to the breast, mammograms may show 'macro calcifications' which are clumps of large calcium deposits and cysts are also commonly seen. An experienced radiologist will be able to discern these as benign post-operative changes. These finding are also common with other breast surgeries such as breast reductions and lumpectomies. So far, there has been no known increased risk of breast cancer.Fat is great for a modest, natural augmentation. Make sure that is what you want. Have a frank discussion with your surgeon. Make sure you are clear on what your goals are. Many woman are keen on having "natural looking" breasts only find out that the happiest day was the day after the procedure when they are at maximum swelling and volume. After the swelling comes down and 30% of the fat resorbs, they want to be bigger again.
Thank you for your questions regarding fat grafting (transfer) for breast enlargement. I am assuming that the 4 separate questions posed are all from the same individual, so I will address all here.In regards to "maximum" amount of fat that can be transferred to the breast, this is dependent on many factors, but the most important: The current size of your breast, the relative laxity of your breast skin and tissue and the amount of donor fat you have. The total volume of fat that can be injected in a single surgery can be enhanced with the preoperative use of the Brava Bra system, which allows for external pre-expansion of the breast envelope to then accommodate more fat. Without the use of Brava, you may be able to gain a cup size worth of enhancement. With the Brava, you can safely and reliably place 3-4x that amount of fat into the breasts. The ASPS (American Society of Plastic Surgeons) has neither endorsed nor recommended against the use of Brava for fat grafting to the breast. We know it to be safe and the research has proven it to be the only effective method for predictable, single stage "Large-Volume" fat grafting to the breasts. An alternative to Brava and Large volume fat grafting is what is known as "Bi-Lamellar Breast Augmentation". This approach utilizes a smaller implant (either saline or silicone) and the simultaneous layering of fat around the implant to smooth the contour and provide larger enhancement with a truly "natural' breast shape and feel.In accomplishing breast augmentation with fat grafting, fat is injected into and around the breast tissue, including the subcutaneous space and into the pectoralis muscle as well. Again, the current condition of your breast, symmetry and relatively density of the tissue determines where the fat is best injected. This is based on surgeon judgment and experience.The method of liposuction to be used should NOT be Ultrasonic, Laser or any other alternative to traditional, standard negative pressure. Fat grafting to the breast is dependent upon fat cell survival for a lasting result. The various methods of "assisted" liposuction all cause rupture or lysis of the fat, therefore the cells are dead when they are removed from the donor site. If this fat is injected into the breasts, it will simply resorb in time, allowing your breast to shrink again. Worse yet, the dead fat cells may cause cysts or nodular irregularities known as calcifications......all things to be avoided.My recommendation is to locate a Plastic Surgeon with experience in this type of procedure. Be certain that your surgeon is board certified by the American Board of Plastic Surgery. Schedule a consultation and he/she can discuss this procedure and alternatives with you in detail. You and your surgeon can then decide on an approach that best works to bring you the results your in search of. Good Luck!
