Fat Transfer for Breast Augmentation: Does it really work? Yes!
Fat transfer to the breast is a very, very hot topic. In fact, it was front and center at the 2011 annual meeting of the American Society for Aesthetic Plastic Surgery which I attended in Boston. I went to every session on this topic and came away convinced that this was a procedure that would be of benefit to certain patients desiring a modest increase in breast size. I am so glad that I have added this procedure to my practice. I have been very pleased with the outcome as have my fat transfer patients. In fact, as of late 2014, I do as many fat transfers for breast enhancement as I do breast implants.
- Costs : $8500 – $10,000 depending on how many areas are used for fat harvest and how long the procedure takes. If you have sticker shock reading this, remember that you are also getting liposuction of your fatty areas.
- How much it hurts: Not much. Both the donor areas and the breasts ache for several days.
- How big can I go?: Plan on one cup size. If you are willing to have two sessions, I can likely get you a 2 cup size increase.
- Will I need Brava?: If you have not had children and/or your breasts are tight, you may benefit from Brava for 4 weeks before surgery. If you have had children or weight loss and have loose breasts, you likely do not need Brava. Very few of my patients have used Brava and have been very pleased with their results.
- Time off work or school: Usually about a week.
- Time until driving again: 5 – 7 days or until you are off your narcotic pain meds.
- Time in post-operative bra and support garments: Usually 3 weeks.
- Time off the gym: Usually 4 weeks.
- Time off the slopes: ditto.
- Time off the kite board: Usually 6 weeks.
- How long it “lasts”: This remains to be determined. I have 3 year follow-ups with good retention of the added fat. I have one patient requesting another session to get an additional cup size increase.
- Patient satisfaction: So far, it’s very high.
And here’s the fine print:
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 then 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 with good results. I use meticulous technique that I learned from Dr. Sydney Coleman, the fat transfer guru. Now it is looking like fat transferred to the breast using this meticulous technique is 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 calcification associated with cancer from calcification 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 an A cup to B cup but taking a AA to a C is not possible.
Fat transfer is a nice way of filling out the upper pole of the breast. This is the area that atrophies with weight loss and/or breast feeding. Most ladies with this problem have loose skin and breast tissue and are good candidates for some filling in of these areas with fat transfer. The loose tissue allows injection of a fair amount of fat. Fat transfer can also shape the breast in ways an implant cannot.
Patients who have not had children or weight loss and present with really tight breasts are more challenging. The best results with women with super tight breasts are in patients 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, about the size of a mixing bowl, used for lactation. Patients need to wear Brava 10 hours a day for about 4 weeks prior to fat transfer. The Brava system stretches the breast and increases the vascularity of the breast. Thus pretreatment with Brava 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 recommendation for women with super tight breasts. Check out the Brava web site for more information on this device.
Fat transfer is 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 4 hours or longer! 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. And sometimes I have to suction a lot of different areas to get enough fat, especially on a slender patient. After the fat is harvested, it is filtered to remove fluid and liquid fat and is then loaded into syringes. Then the syringes and specialized injection cannulas 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. This is not a procedure that should be done by a surgeon who is always watching the clock and has the need for speed. Check out this blog for why it takes sooooo long.
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 in as much of a size increase as the patient (or me) had hoped for.
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, and have enough fat to harvest.
And now for the upside: fat injection can result in a nicely enhanced breast without the expense and upkeep of a breast implant ………. and it’s all natural! And fat transfer allows me to place the fat where it is needed and build up the breast mound gradually. Oh, and one more thing: those saddle bags and muffin tops? Gone!
To schedule a consultation with me, please call 206 467-1101.
As of November, 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. Careful patient selection is very important. They need to have enough fat for harvest and need to be satisfied with a subtle enhancement. I am currently very enthusiatic about this procedure.