I have been performing fat grafting for over 25 years with excellent success. Fat injections has worked beautifully for augmenting lips, laugh lines, frown lines, and defects throughout the body, including indentations from injections, trauma, or irregularities from liposuction. Finally, with the blessing of research as well as the American Society of Plastic Surgeons, fat grafting is coming into vogue for augmenting breasts for reconstructive purposes, even irradiated breasts to help in skin tone and begin to soften scar tissue about the breasts. Fat transfer to the breasts is nothing new. It was done almost 30 years ago but was not encouraged, as it was felt that it might perhaps hide early detection of breast cancer using mammography. However, more recent studies and information coming from a variety of sources have shown that this may not be as much a worry as it has been in the past. In fact, there has been tremendous interest in transferring one’s own body fat from perhaps the hip or abdominal area to the breasts in breast reconstruction. There are studies, in fact, encouraged by the American Society of Plastic Surgeons to further evaluate fat grafting to the breasts both using direct fat from another body area of that same individual to the breasts as well as fat stem cells to the breast area.
I have noticed very encouraging early preliminary studies in my own practice of performing fat transfer to the breast area. There have been encouraging results in loosening the skin and getting better skin texture and tone when putting fat under mastectomy scars or even under irradiated tissue. In my own practice, I have been augmenting breasts either primarily or after removal of breast implants with fat with very encouraging results. Candidates have to be chosen carefully and understand the procedure involved. Usually, this is done over a 3-12 month period in multiple sittings. The patient has to have good donor sites to take the fat from the abdomen or thigh area and transfer it in a variety of sessions to the breast area and allowing for adequate blood supply to surround all the fat cells and allow viability and growth. Experience plays a significant role and, therefore, my 25 years of performing fat injections throughout the body with excellent results has made my transformation to applying fat, which is called autologous fat grafting, to the breast area with, as mentioned above, very encouraging results. I usually like to perform the fat grafting over several sittings spaced three months apart. The three months allows for the fat to get blood supply and, therefore, further sittings can be done on top of the older fat cells that were placed several months earlier. Therefore, if a person is a good candidate after a thorough physical examination and informed consent, I will start the process.
Fat transfer to the breasts can be done just for routine augmentation and/or for a patient who desires to have their breast implants removed and replaced with fat. It also, as mentioned above, is excellent for breast reconstruction or scarring about the breast area or patients who have had radiation following a mastectomy. I like to use smaller volumes of fat in the range of 50-100 cc at each sitting spaced three months apart and slowly build up either breast with that amount of fat. If too much fat is placed at one time, not enough blood supply gets to the fat cells and, therefore, the viability of the fat cells is jeopardized. It is much better to use smaller volumes of fat and build up the breast over several sittings spaced three months apart for the most desirable result. More and more research is coming out that is showing that this potentially could be a very viable procedure without the risks and concerns that have been voiced in the past about potential masking or difficulty in detecting early breast carcinoma. The positive feedback that I have received from patients has been exuberant, and it gives me encouragement to continue my cautious and careful ongoing fat grafting sessions to the breasts. These are done in an accredited operating room facility with often an anesthesiologist present and under a very controlled circumstance. Discomfort to the patient is minimal.
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