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          Fat Grafting Breast Augmentation: A Special Report

          If you are thinking about breast augmentation, but are not really sold on implants, fat transfer, or fat grafting, to the breast may be an option.

          Fat grafting to the breast, or "natural breast augmentation," involves taking fat from places in the body such as your buttocks or thighs, where it is plentiful, and implanting it in your breasts. Also known as autologous fat transplantation, fat transfer to the breast was once ill-advised, but it is slowly and surely finding its place in the repertoire of many breast augmentation surgeons.

          As it stands, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery state that fat injections to the breast can be used to enhance breast appearance after breast reconstruction or to soften the appearance of implants by eliminating wrinkling, dimpling or even capsular contracture. These injections may one day have a role in primary cosmetic breast augmentation.

          Fat Grafting to the Breast: The Controversy

          Some doctors were initially concerned that injected fat might calcify and obscure readings on breast X-rays (mammograms) or be mistaken for early breast cancer. The latest studies show no such risk. In fact, it's actually easier to visualize breast tissue in breasts that were augmented with fat compared to breast tissue in breasts with saline or silicone implants.

          Fat grafting breast augmentation may not affect breast cancer risk or detection, but there are still technical concerns surrounding its use. For starters, there is no consensus regarding how much fat is needed to adequately enlarge a breast. Additionally, the fat must develop a blood supply of its own to survive. If it doesn't, it disappears. If it does develop a blood supply, it becomes a living tissue and can grow if you put on weight or shrink if you lose weight.

          So the questions remaining are how much is too much and how little is too little? The answers are not yet known. Fat transfer breast augmentation's success also depends on your surgeon's skill and technique.

          Fat Grafting to the Breast: The Stem Cell Solution

          Some plastic surgeons who perform fat grafting to the breast say the secret to their success is in the stem cells. "Pluripotent," adipose-derived stem cells live in fatty tissue and can change into any of the types of cells found in the human body — including fat cells. These stem cells should not be confused with controversial embryonic stem cells. Instead, they are viable adult stem cells that can be extracted from your own fat.

          Certain fat processing techniques may yield higher concentrations of adult stem cells, which may provide long-lasting, breast-enhancing results. These stem cells basically regenerate fat from within, turning cells into mini fat cell factories. This approach is widely used in Europe and Asia. There is no evidence showing that injecting fat replete with stem cells into the breast will induce the growth of breast cancer.

          Fat Grafting Breast Augmentation: Are You a Candidate?

          Fat transfer to the breast may be an option if you are attempting to enhance your breasts' appearance after breast reconstruction or want to soften the look of your implants.  As far as primary breast augmentation goes, fat grafting, in the right hands, may provide breasts that look and feel more natural. Some women do not like the feel of a saline breast implant, while a breast that is enhanced with autologous fat does feel natural. Fat grafting to the breast can increase breast size (but likely by less than one cup), create cleavage and improve the shape of tuberous or "Snoopy" breasts. These enhancements may even be permanent, or semi-permanent with some maintenance injections.

          Fat Grafting to the Breast: What to Expect

          Fat grafting to the breast is basically a two-part procedure. The first step is to harvest and process the fat. The fat can be harvested via liposuction, ultrasound-assisted liposuction, laser liposuction or water-assisted liposuction.

          Some new technologies also have a role in fat grafting to the breast. For example, Cytori Therapeutics PureGraft System is the first and only device cleared for aesthetic body contouring using autologous fat in the United States. This technology, which can be used for both small and large volumes, allows your surgeon to process your own fat tissue in approximately 15 minutes. Your surgeon then injects the fat into the multiple layers of your breast in very tiny drops. This technique allows your surgeon to sculpt and shape the breasts.

          Some surgeons suggest wearing tissue expanders such as the Brava System to stretch your skin before the fat injections. Your surgeon will tell you how often to wear the expander to achieve the results you desire. These devices pull your breast tissue and place your breast under tension to encourage the cells to replicate. 

          There are benefits and risks to all surgeries, including fat transfer to the breast. For example, you can't go as big with fat injections to the breast as you could with saline or silicone breast implants. Depending on your goals, this could be a downside.

          Other risks may include cosmetic dissatisfaction, asymmetry, unpredictable results, infection or fat migration. There are also risks relating to the way the fat is harvested. For example, liposuction may be associated with increased risk for anesthesia reactions, infection, or burns (with laser or ultrasound-assisted liposuction, in particular).

          Advocates state that the benefits of fat grafting to the breast over breast augmentation with implants include no risk of rejection or allergic reaction since it is your own tissue. Fat transfer breast augmentation also allows doctors to sculpt the breast, as opposed to placing pre-formed, manufactured breast implants.

          Breast Augmentation Fat Transfer Cost

          This procedure takes longer to perform and costs much more than breast augmentation with implants. Prices vary based on the amount of fat that is harvested and how much is re-injected, but may start at $20,000. Total cost for breast augmentation with implants ranges from $5,000 to $15,000.

          Fat Grafting to the Breast: The Bottom Line

          Fat injections do have a role in breast reconstruction and in enhancing the appearance of implants by evening out irregularities. They may have a role in primary breast augmentation if the procedure is performed by an experienced surgeon, the availability of which will likely increase as more surgeons refine their techniques for fat grafting breast enhancement.

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            Joseph A. Mele, MD, FACS

            130 La Casa Via
            Building 2, Suite 206
            Walnut Creek, CA 94598
            (925) 943-6353
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          • 95 Scripps Drive
            Sacramento, CA 95825
            (916) 929-1833

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            A.J. Khalil, MD

            A.J. Khalil, MD
            436 North Roxbury Dr
            Suite #207
            Beverly Hills, CA 90210
            (323) 856-1941
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