Autologous Fat Transfer for Breast Augmentation according to Seattle Cosmetic Plastic Surgeon, Dr. Lisa Lynn Sowder
Autologous fat transfer for the breast is a very, very hot topic. In fact, it was front and center at the 2011 annual meeting of the American Soceity for Aesthetic Plastic Surgery which I attended in Boston in early May.
As of August, 2014, I have done fat transfer for breast augmentation on 23 patients (that’s 46 breasts!) and thus far have had favorable results, high patient satisfaction and no complications. I am very, very selective about which patients I offer this procedure to. Careful patient selection is very important. I am currently very enthusiatic about this procedure but keep reading to get more information on the pros and cons of fat transfer to the breast.
For years the idea and practice of injecting fat into the breast was frowned upon as being an ineffective and often dangerous procedure. The issue was that the fat did not survive and underwent a process called fat necrosis that would leave lumps of calcified scar tissue in the breast that would then interfere with mammograms. The method used was harvesting the fat using the same technique and equipment used for liposuction and injecting large volumes of fat into the breast.
Well, that was then and this is now and now we know that the technique of both harvest and injection determines whether or not the fat has a chance to survive in its new location. I’ve been doing fat transfer to the face and body and areas around the breast for over a decade. I use the technique called “Lipostructure.” Now it is looking like fat transferred to the breast using this meticulous method is likely to be both safe and effective. The fat has a good chance of surviving and the chance for fat necrosis is also much smaller. Also, mammograms and the radiologist who read them have gotten much better at distinguishing calcifications associated with cancer from calcifications that are seen with benign conditions. In fact, other breast procedures such as a breast reduction or a breast lift cause more mammogram changes that fat injection does.
There are several disadvantages to fat transfer to the breast. The first is that many women requesting augmentation are slender and don’t have much in the way of donor areas for the fat. The second is that a large augmentation cannot be done. Fat transfer may increase the breast by one cup size, say a cup to B cup but taking a AA to a C is not possible.
Most of my patients have had fat transfer without the preoperative or postoperative use of Brava, which is a gigantic breast pump device that can increase the circulation of the breast and also loosen up the breast tissue and skin in patients who are super flat and super tight. The Brava system is very labor intensive and, for most patients, uncomfortable and intrusive on their day to day activities. It takes a very dedicated patient to remain compliant with the recommended Brava schedule. If I think a patient absolutely needs Brava to make the fat transfer successful, that is discussed at the consultation. Check out the Brava web site for more information on this device.
Fat transfer is a time intensive procedure. My average operating time for breast augmentation is about 1-1/2 hours. Operating time for fat transfer is much longer. Sometimes up to 6 hours! This increases the expense and the risk of surgery. The reason it takes soooooo long is that the fat is harvested using low suction as opposed to the high suction used for typical liposuction. After the fat is harvested, it is centrifuged to remove fluid and liquid fat and is then loaded into smaller syringes. Then the smaller syringes are used to inject little small particles of fat into the breast. The smaller the particle, the better chance of survival. This is a lot of futzing around and it is necessary futzing if the fat is expected to survive. I am lucky in that patience is one of my virtues. I can spend all day futzing around to do it just right as long as it’s going to work.
And last but not least, fat transfer is just not as predictable as augmentation with an implant. I know a 300 cc implant is going to result in a 300 cc larger breast. But even in the best hands, fat transfer may not always result as much volume increase as the patient (or me) hoped for, regardless of how much fat was injected or how it was injected.
I am pleased to offer this exciting new procedure but limit the procedure to those who can tolerate some unpredictability, desire only a little enhancement, have enough fat to harvest, are willing to commit to 4 weeks of Brava expansion if recommended and who can tolerate a procedure that is longer and more expensive than standard augmentation.
If you would like to set up a consultation for fat transfer to the breast or any other procedure I perform, please give my office a call at (206) 467-1101.