I Have Sickle Cell Disease and Want a Breast Augmentation by Fat Transfer

Question

I'm a thin lady with flabby stomach and breasts due to having two kids. I also have Sickle Cell Disease, so with my hematologist's okay (which I did get), will it be hard to find a certified plastic surgeon who's willing to perform my breast augmentation?

	If not, is it safer to get implants or get fat transferred from another part of my body into my breasts(I believe there's a term for that procedure!) Also, what is the cost difference between the two procedures? Thanks in advance for responding!

David Bogue, MD · Answer

Sickle cell disease is not a contraindication for breast augmentation. The decision for fat transfer breast augmentation versus implants is a separate question. In reality, fat transfer typically involves large amounts of fat and can take several hours to properly harvest, separate, and inject. I would not recommend this as a local or sedation procedure. In addition, the breast enlargement achievable with fat transfers is modest at best (typically a cup size), assuming the fat lives. Implants will involve less total anesthesia and a more predictable result.

Aaron Stone, MD · Answer

Hemoglobin is the protein in red blood cells that carries oxygen. It is encoded by 2 genes in one's DNA. Either or both of these genes can have a sickle cell trait so that the hemoglobin produced by either or both as the case may be is abnormal. If only one gene is abnormal the individual is said to have sickle trait. If both are involved the individual has sickle cell. Under low oxygen levels the sickle hemoglobin changes shape and makes the red blood cell it is in turn into a sickle shape. Conditions that make the abormal cells sickle include lowered body temperature, infections, acidic metabolic conditions, dehydration and as mentioned lowered blood oxygen levels. The abnormal blood cells have a shorter life span and tend to get caught in the smaller blood vessels of the body. The manifestation of this depends on the percentage of total body red blood cells/hemoglobin that is abnormal. Those with only the trait (one gene) have an easier time. When the percentage is high it is associated with anemia, stunted growth, sores on the legs, heart problems etc.

	The affect on cosmetic surgery and the measures needed to ensure safe surgery depend on the percentage. At low percentages you do not need to do anything different from other patients. At higher percentages the patient may need pre-surgery treatment with oxygen, blood transfusion, hydration etc. If the percentage is high the patient should probably not be having elective cosmetic surgery. Your surgeon needs to work together with a hematologist in order to ensure a smooth recovery after surgery.

	In your case it is impossible to say what surgery you should have without photos or preferably a face to face examination. It sounds like you need what is referred to as a mommy makeover i.e. treatment of the abdominal area as well as the breasts. That may also mean removal of excess abdominal and/or breast skin depending on what you start with and what result you want.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Vasdev Rai, MD · Answer

If you want breast enlargement, you need breast implants. Sickle cell disease would not pose a problem.  Fat transfers don't work and in long term cause harm and thus should not be done.

Darryl J. Blinski, MD · Answer

Before having this surgery a complete written heme, anesthesia clearances are needed. Than I might consider doing your surgery as an in patient for the safest path.

Rafael C. Cabrera, MD · Answer

I believe if you are a good candidate for fat transfer to the breast then that would be the preferable procedure. I say this not because of potential problems with implants, but because doing fat transfer under local with mild sedation is very comfortable, while submuscular breast aug generally requires general anesthesia. this is important becasue the physiologic changes that occur with general anesthesia (pooling of blood in extremities, low/high blood pressure, and loss of muscle tone) may predispose you to a sickle crisis. If you needed implants because fat was not a viable cosmetic choice, then implants could be done under the breast, over the muscle with local or intercostal blocks and mild sedation, again avoiding gen anesthesia. good luck

Jonathan J. Staiano, FRCS (Plast) · Answer

You should be fine to have breast augmentation with sickle cell disease.  As long as your surgeon and the anaesthetist are aware, they should be able to make sure that you do not suffer any ill effects.

	There is a big difference between having implants or fat transfer and you will need to discuss this with your surgeon.  Implants is a quicker procedure and so may be preferable given your condition, but there are potential long term complications with implants and so you will need to weigh up the pros and cons.

	Good luck.

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