Fat transfer to the breast as part of my mommy makeover. Is it safe?

Question

I’ve been interested in a mommy makeover for sometime. I do not want breast implants as I really just want fullness not to increase breast size and do not want anything foreign in my body. I am interested in fat transfer to the breast. I believe I would have enough fat to harvest. My question is: why are there so many conflicting articles on whether or not this procedure is safe and it’s implications on mammogram results? I had to be screened for several years because I had breast cysts.

Justin Yovino, MD, FACS · Answer

I perform this procedure a lot with many years experience.  When performed gently and meticulously and in the correct areas of the breast it is a very low risk procedure with a high Satisfaction. In my opinion, even though breast implants are widely popular and safe, breast implants have a much higher risk for complications and reoperations compared to fat Transfer to the Breasts.

Yannis Alexandrides, MD, FACS · Answer

You are right - this is a controversial method. If a Doctor suggests you should have fat injections, they should explain to you why this might be a controversial issue, and why in certain cases fat injections could cause alterations within your breast which could look cancerous, making any follow ups very difficult. In your case, it looks as though you have already had complicating factors with the breast cysts which may make fat injections a less suitable option for you.

Alex Campbell, MD · Answer

Thank you for your question. Fat transfer to the breast has become more popular in the press, but we do not perform this procedure as we do not believe that it has been properly proven as a safe, dependable, and cost effective means of performing breast augmentation. There are also possible side effects that one must consider, including the risk of scarring on a mammogram that can complicate detection of breast cancer.  Other side effects are possible infection, fat resorption necessitating more sessions of fat grafting, and possible asymmetry.    Implant based breast augmentation, on the other hand, is very safe and predictable with an extremely high patient satisfaction rating in our practice.  Fat grafting is best for breast contour irregularities.  Very large amounts of fat and possible multiple sessions would be needed to approximate the result of large breast implants for breast augmentation.

William Bruno, MD · Answer

Fat transfer to the breast is quite safe if performed with proper technique. Interpretation of mammograms by radiologists is quite good at discerning between transferred fat and breast pathology (cancer). A consultation with an experienced plastic surgeon can tell if you in fact a candidate or not for a fat transfer to the breast. Watch this brief video for more information.Best wishes,Dr.Bruno

Kenneth Hughes, MD · Answer

In general, 200 cc per breast is typically the upper limit of fat injection recommended by most plastic surgeons.  It is not that more cannot be injected; but on average, this has been determined to be the most that can be expected to live during one transfer. Fat transfer to the breast could improve the fullness of the breast, particularly at the top of the breast. If you want more than a one cup size increase, this may require multiple treatments to reach the size you desire. About 50% of the fat obtains permanence.  Fat is placed within the subcutaneous fat (underneath the skin, around the gland, and underneath the gland) with one tiny incision under each breast while the patient is under general anesthesia.Cysts, lumps, necrosis, failure of the graft, and microcalcifications are the enumerated risks.  Radiologists assure us that they can differentiate calcifications from cancer.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Krishna Dash, MD · Answer

Thank you for your question. Like any plastic surgery procedure, breast enhancement using fat transfer is safe when performed by the right surgeon. I recommend that you schedule a consultation with a board-certified plastic surgeon who is experienced in breast augmentation and fat transfer procedures. They can examine you and offer the best options for achieving the results you desire, as well as addressing any questions and concerns you might have. Good luck! 
Regards,Krishna Dash, MD

Lisa Cassileth, MD, FACS · Answer

It is safe if the right surgeon does the fat grafting! The ASPS ruled the procedure as safe, but it must be done correctly, as the fat can necrose (ie die) if put in in big globs. Imagine, fat is a living tissue, and it is alive, like a skin graft would be for a burn patient. Each cell needs the best environment for survival, which means it is placed gently next to living cells. If too many fat cells are instead placed next to each other, then they won't get enough blood flow or nutrients, and they will die. So the injection technique is VERY important, as is the timing, as the fat must be used immediately and never frozen or allowed to sit around. Here are the key items to double check with your surgeon:1. Fat is harvested and used immediately (we only harvest 200cc at a time, process it, and immediately inject it)2. Fat is bloodless and all tumescent is removed as well as damaged cell/free oil3. Fat is packaged into 3cc syringes (NEVER 60cc!)4. Fat is injected in 0.1-0.2cc aliquot strips, so injecting as little as even 100cc can take 1000 passes of the inejciton cannula5. Injection cannulae are always blunt and 16 gauge (for breast)Don't be afraid to ask, in fact I love it when patients express interest, as doing it the right way takes a lot of extra effort but is totally worth it. The hardest thing about it is that you can reliably only double your breast size, so don't expect to go from an A to a DD!

Camille Cash, MD · Answer

Fat transfer to the breasts can be done as part of the Mommy Makeover procedure.  It is a good option for you to consider if you do not want an implant.  Breast cancer screening is an important part of your health regimen.  The radiologists should be able to read the results from the imaging after a fat transfer.  I recommend visiting with a board certified plastic surgeon in your area to learn more.

Mark Deutsch, MD, FACS · Answer

Fat transfer is done routinely for breast reconstruction after mastectomy but in select cases can also be done for cosmetic purposes. Generally speaking it is best for filling out contour deformities rather than increasing cup size. It is best to discuss this with your surgeon to see if you were a good candidate.

David A. Sieber, MD, FACS · Answer

Thanks for the great question. Performing fat grafting at the same time as a mommy makeover is definitely possible in the right patients. You bring up a great question about safety with mammograms. There have been studies evaluating the safety of fat grafting and mammography and they are able to tell the difference between breast cancer and the grafted fat. They have also evaluated women who had breast reductions vs those with fat grafting to the breast and the women who had breast reductions actually had more oil cysts in the breast after surgery than the women who just had fat grafting. I hope this helps!Best,~Dr. Sieber

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