In Part 1 of this series on fat grafting – “Fat Transfer, Part 1: Facial Rejuvenation – Will Fillers Become Obsolete?” – we covered the basics of transferring live fat cells from one area of the body (typically, the abdominal or thighs) and injecting them into to the face:
-How the fat is “harvested” and prepped
-What factors contribute or impair the survival of the live fat cells
-How skin quality is enhanced simultaneously
-And the technique for injecting the fat.
Fat is a natural substance, and fat grafting’s ability to add volume and enhance skin quality has made it a very popular procedure. But we would be remiss to discuss this topic without touching on its amazing ability to enhance the body, which leads us to – Part 2: Natural Breast Enhancement.
We spoke with Beverly Hills based cosmetic surgeons Dr. Andre Berger and Dr. David Mashhadian of Rodeo Surgical Art, and New York City based board certified plastic surgeon, Dr. Lara Devgan, to get a better understanding of fat grafting for natural breast enhancement.
Who’s the right candidate?
-Someone who has enough excess fat to give
-Concerned with fullness, not droopiness
-Wants subtle enhancement
“It’s for women who would like a natural breast enhancement and are not interested in anything more than 1.5 – 2 cup sizes. But they have to have enough fat to give. Sometimes you have women who are extremely fit and we see this a lot in California. We see women who are lean and they want larger breasts but we cant do much for them unless they gain 15 pounds to find enough fat. You have to have to be at least average weight with an adequate amount of normal body fat to give,” says Dr. Berger.
“Typically we see women who have had one or two kids. They lost fullness in the upper breast and they just want to get some of that fullness back. Their breasts aren’t droopy but they just need a little natural breast enhancement. Those candidates get a good results. If the breast is too droopy, meaning the nipple descends too low, then the natural breast augmentation will not create a lift and they will still be low.”
How is the procedure done?
(For more on the technique of harvesting and transferring the fat cells – read Part 1 here.)
“It can be done without the need for general anesthesia. It can be done with local anesthesia. The patients are able to walk in and walk out the same day and it’s a very nice recovery,” says Dr. Berger.
-40-50% of injected fat won’t survive resulting in a need for multiple treatments
-1-3 treatments needed on average for natural breast enhancement
“I counsel my patients that about 50% of analogous fat that’s transferred will not take. And by take I mean survive in the longterm. The problem is that even with excellent, meticulous technique it’s difficult to predict which areas the fat grafting will take, so it’s possible if you have fat grafting you will need some touch up procedures to correct asymmetries,” says Dr. Devgan.
“It doesn’t always require only one course of injections. Typically, 1-3 procedures in a series is needed. But since it’s natural breast enhancement, it will last for many many years compared to synthetic breast implants,” says Dr. Berger.
How does fat grafting compare to synthetic implants?
-Fat grafting is natural, synthetic implants are not
-Fat grafting is lifelong, synthetic implants temporary
-Synthetic implants: have to be replaced, must be monitored for ruptures, could have complications
“There is a 20% complication rate with synthetic implants, which have to be changed on a regular basis and so natural breast enhancement with fat transfer is a great natural alternative,” says Dr. Berger.
“What I tell my patients is that breast implants are not a lifetime device. You weren’t born with them and they are a medical device. At some point in your life you are going to have to have them changed out. You have to pay attention to them and get routine MRI surveillance of them to make sure that you aren’t missing a silent rupture or silent leak of the implants. If you get in a car accident, have breast pain or you notice asymmetry you should go see your plastic surgeon, get some imaging and see if you need to have your implant switched out. If you are doing fine at the ten year or fifteen year mark you can keep the implants in, but know in the back of your mind that you will need a second operation at some point. I usually say 10-20 years after the first procedure they will need to be replaced,” says Dr. Devgan.
-Possibility of irregularities
-Less predictable than synthetic implants
-Requires an expert injector
“Right now the procedure is still in its infancy. It is controversial and highly important that patients seek out expert surgeons because the surgeon has to make sure that the fat is injected into the right area. The fat should not be injected into the breast tissue itself because it can cause scarring and irregularities in the mammogram making it very difficult for the radiologist to make appropriate diagnosis. That’s one of the issues with calcification and scar tissue of that nature,” says Dr. Mashhadian.
“It’s also possible that you may have some other downsides including fat necrosis, which is when some of the fat cells die and they become a little bit hard. You can also have some asymmetry and bumpiness or lumpiness. It’s not a perfect operation, but it is a powerful tool and its really great in select patients,” say Dr. Devgan.
Fat grafting and implants?
-Great for mastectomies
-Added size boost
“Fat transfer is especially great in women who have had breast cancer reconstruction surgery. With breast cancer, you completely remove the breast in a mastectomy and completely rebuild the breast with an implant. In these women, they essentially have no breast tissue – just skin, muscle and an implant – so fat grafting can be a really nice way to smooth out the whole transitional area. Almost like a sculpture using a little bit of extra clay to smooth out the breast and implant.
“For women who are using it for cosmetic surgery, you can also use fat grafting in the same way. It’s nice to use it for small volume, shaping and contouring for a little bit of a size boost, but you are not going to go from an A cup to a D cup with fat grafting alone,” explains Dr. Devgan.
Disclaimer: Any information in the publications, messages, postings or articles on the website should not be considered a substitute for consultation with a board-certified dermatologist or plastic surgeon to address individual medical needs. Your particular facts and circumstances will determine the treatment which is most appropriate for you. And the outcomes.
Written by Amy Chang; Image source: photographer, Franzo Assenza