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 March, 2013, I have done fat transfer for breast augmentation on 12 patients (that’s 24 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.
Fat transfer to the breast also requires a lot of effort on the part of the patient. The best results are in women who undergo breast expansion using a device called Brava. This is basically two plastic domes that fit over each breast and provide continuous suction. Imagine a gigantic breast pump used for lactation. Patients need to wear Brava 10 hours a day for about 4 weeks prior to fat transfer. The Brava system expands the breast and increases the vascularity of the breast. Thus pretreatment with Brava it provides room for the added fat and it provides increased blood supply so the fat is more likely to survive. Wearing the Brava device is not an easy task but it is a requirement except for some women who are already quite loose and want just a teeny, tiny bit of increase in size. Check out the Brava web site for more information on this device.
Fat transfer is also a very 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 an implant is going to result in a larger breast but even in the best hands, fat transfer does not always result in a long lasting result, 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 and who can tolerate a procedure that is longer and more expensive than standard augmentation.