Fat Grafting of the Breast

Fat Grafting Breast

HISTORY

Fat grafting to the breast can be traced back to as early as 1893 with a long trail of published articles. It did not really become popular until 1987 with anecdotal reports of procedures by Mel Bircoll MD in Los Angeles. That same year our society the ASPS put a two-year moratorium to stop fat grafting to the breast until more research was done. Subsequently basic science research occurred rapidly. Quickly plastic surgeons dedicated a great deal of investigation, effort and interest to making this procedure safe and predictable. Beginning in around 2000 a great deal more research has been dedicated to this and continues in a supercharged fashion. We have learned:

1. Fat can be safely removed from areas in the body (basic principles of liposuction) and injected safely into the breast.
2. Much research has been dedicated to resolving that issue of whether the grafted fat stimulates cancer or confuses the diagnosis [of microcalcifications] on mammography. The conclusion is there is no risk of increasing cancer. Mammograms will not negatively impact the grafted area. See THIS JOURNAL ARTICLE
3. Most of the fat grafted survives.
4. Benign fat cyst formation is common in the breast.
5. We do not really know the exact science behind any fat grafting procedure or how to enhance fat graft survival.
6. We do know it works and is mostly safe

CONCEPT

Thanks to this relatively new and now rapidly evolving procedure, techniques, and technology; we have accumulated a great deal of experiences that has made this a truly viable option for natural enlargement of the breast in appropriately chosen patients.

The basic concepts and principles of fat grafting are the same as for fat grafting in any other part of the body:

1. There must be an adequate donor area of available fat for grafting
2. There must be a recipient site that is expandable with fat and have a good blood supply
3. Fat must be harvested in such a way to as best preserve viability so the new blood supply can grow into the grafted fat
4. The goal is once the fat is grafted that the new blood supply will grow into the fat cells and these cells will maintain MOST OF their shape and volume forever.

The specific concepts and principles for fat grafting of the breast are:

1. The basic science of taking fat from one part of the body and grafting it into another; in this case the breast.
2. Using fat graft to enlarge and shape the breast. Since fat cells are fragile and compressible, these cannot be used to expand the breast, but can fill up a loose breast if this is possible and, if so, to what degree.
3. Issues and questions:
   1. Biggest challenge is to honestly and accurately manage patient expectations
   2. Not a good option when removing breast implants unless patient has abundant natural breast tissue remaining.
   3. Limitation of size, shape and picking the correct surgery for the patient.
   4. What are the issues with mammography and cancer enhancement and detection?
   5. How common is cyst formation and what are the effects and tradeoffs for this?
   6. How much and how many areas are available for liposuction and “donor fat”?

ADVANTAGES

1. No use or dealing with implants.
2. NO IMPLANT ISSUES. No issues of incision, dissection, pectoralis muscle, sensation, and contracture
3. SOFT AND NO PALPABLE EDGES.
4. ARTISTIC AND CUSTOMIZED. You can place large or small amounts of fat in specific areas rather than just a “global” enlargement as with an implant.

DISADVANTAGES

1. Limited by amount of fat available
2. Limited by the amount of expandability of the breast
3. Limited by shape of breast and since fat is soft and compressible, it cannot stretch or round out the breast like an implant.
4. Limited in size you can achieve
5. Mostly more time consuming and expensive

TECHNIQUE

1. General anesthesia is used
2. Liposuction is performed with special cannulas and specialized collection apparatus, washed, prepared, antibiotics added, and loaded into injection syringes
3. Using specific small cannula, the fat is injected in “MICRO-TUNNELS”. This is to create very small thin threads that will allow for better penetration of the new blood vessels to give “life” to the fat graft.
4. The injections are performed at different levels in different areas to artistically enhance the breast shape and size
5. Only small incisions are used for both the liposuction and fat grafting, less than ¼” in all areas.
6. Compressive breast and liposuction garments are applied.
7. You awake from surgery comfortably. There is minimal or NO pain. You go home and resume most activities the next day.
8. You see a result right away. Some swelling resolves slowly over time but you still achieve a result that lasts forever and does not “fade away” with time.