Tuesday, 19 June 2012

Fat Transfer Breast Augmentation (Natural Breast Enlargement)

The History of Breast Augmentation

Breast augmentations are one the most common female cosmetic procedures performed. In 2010 the USA performed 13 million cosmetic procedures (ASPS). Of these, 300'000 were breast augmentations. The majority of these were Silicone based implants followed by Saline filled implants.

The first breast implant procedure was performed 50 years ago. The patient, Timmie Jean Lindsey, now 80 years, was very please with the result and the implants are still "alive".
Over the last 30 years the industry has evolved immensely.  Numerous implant manufacturers have come and gone and surgical techniques have been improved on and modified.
The first implants were silicone based and subsequently other types have come onto the market including soya based and saline filled implants.
Currently the most common type of implant used is Silicone.  The choice of implant used depends on the desired shape and size the patient requires and also on surgeon preference.
Other augmentation procedures that exist are musculo-cutaneous flaps (muscle and skin grafts; DIEP, TRAM, Lattissimus dorsi) that are taken from one area and transposed to another.  These are mainly used for reconstruction purposes for cancer survivors.  Occasionally surgeons also use tissue expanders to create an envelope and then insert an implant.

With the cosmetic industry being flooded with dermal fillers the aesthetic company Q-Med launched a product called Macrolane (Hyaluronic Acid filler) which was used as a body contouring filler.  It is a degradable product which is injected into a pocket underneath the breast tissue and is used to enhance the size and shape of the breast.  It is also used as filler for buttocks, calves and male pecs.  The product lasts approximately 9-12 months and then the procedure can be repeated.  At present the license for breast remodelling has been revoked until a consensus can be agreed upon for screening modalities in women with the filler.  The product is still used for general body contouring.  There are no safety issues regarding the product.

Fat Transfer Breast Augmentation (autologous fat transfer)

With the current PIP scandal many women are looking for other alternatives to formal surgery and implant procedures.  Autologous fat transfer or fat graft is fast becoming a popular choice.  The first breast fat graft was performed by an american surgeon and described in the American Journal Plastic and Reconstructive Surgery in 1987.  There was a big uproar by his fellow surgeons as there was not enough scientific evidence to support the procedure, its consequences and risks.

However, in 2007 Sydney Colemen, a major proponent of fat graft procedures, suggested that it was "time to end the discrimination created by the 1987 position paper" and " judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure."

The Procedure
The surgeon will usually do a psychological assessment to ascertain the suitability of the patient and gain insight into the patients' expectations.  The patient then also needs to be assessed for suitability in terms of fat content and breast suitability.  Pre-operative imaging is important to assess symmetry, volume, shape and also for comparison postoperatively.  
Fat is harvested via a liposuction technique and filtered to get rid of any unwanted material such as local anaesthetic, blood, connective tissue etc.  Many women see this as a 2 in 1 procedure as they have fat removed from areas that they don't like and at the same time get an augmentation.  Nowadays the procedure is performed under local anaesthetic and conscious sedation which removes the risks of a general anaesthetic.
The pure fat is then injected into the breast to enhance the shape and size. The limiting factors are really is there enough tissue to chance the breast significantly and are the breasts suitable for the procedure.

Although the procedure is done as a day case it is still a surgical procedure and thus needs to be treated as such. Risks such as infection, abscess formation, bleeding, asymmetry, fat necrosis, fat cysts are important to bear in mind. The fat retention volume is somewhat unpredictable, but presently rates of 50-70% are achieved. This will vary from patient to patient and there is the risk that almost all the fat will be lost.

One of the most important possible side effects is the occurrence of calcifications. When fat does not survive it may form small spicules of calcium that are visible on mammograms. Calcifications are sometimes associated with suspicious lesions on mammograms and often require further investigations and tests. When supplemental imaging modalities are considered such as digital mammograms or MRI scans calcifications from fat necrosis can be distinguished from the malignant signs of irregularly shaped, high-opacity micro calcifications. It is to be remembered that not all fat graft procedures will result in calcifications.
Of the thousands of fat grafts performed to date there has not yet been a case reported of a missed cancer diagnosis on mammogram due to a fat graft procedure.

Numerous scientific papers have since been published on the topic (Fulton, 2003; Spear, 2005; Missina, 2007; Carvajal, 2008; Illouz, 2009; Hiko, 2009; Delay, 2009; Da Li, 2009; Veber, 2011; Cong Feng, 2011; Claro, 2012) and the conferences are full of presentations on techniques, experiences, outcomes and imaging modalities for cancer screening purposes. 

Recently an american author has undergone a cell enriched fat graft to the breast after having a large lump removed (http://tinyurl.com/d6jjmn8).
The largest followup series of fat grafts has been reported by Illouz and Delay looking at over 1000 patients over a 10 year period respectively.  Although there has been heated debate about whether fat graft to the breast will interfere with the interpretation of mammograms the ASPS position paper indicated "no evidence that fat injections interfere with breast cancer detection and that results of fat transfers remain highly dependent on a surgeon’s technique and expertise".

 Fat Transfer Breast Augmentation procedure

Dr Wolf performs 3D imaging on all patients to compare before and after shapes and sizes.
As an alternative to implants the autologous fat graft breast augmentation will certainly become a lot more popular option.  The benefits include day case procedure, conscious sedation, natural look, feel and shape.
The procedure is still a surgical procedure and comes with its inherent risks.  Patients need to be properly assessed, evaluated and consulted regarding the procedure risks and possible side effects.
Here is a post of a very pleased patient.........

Come see our website www.DrWolf.com

Come see our website www.DrWolf.com 


  1. I am really interested in this and your name keeps popping up in my research. A lot of clinics site that the use of the Bravia sysyem afterwards is essential to reduce fat absorption and encourage the fat cells, is this true?

    1. Dear gigi,
      There is not much scientific evidence for this but some Dr do recommend it. Practically it is very difficult to comply with once you see the system. It is very cumbersome having those suction cups applied for so many hours a day.
      I have not had any experience with it. Brava is popular in the US and not really in Europe.

  2. Hi can you comment on the lipo technique you use fir this procedure, how does it affect the fat cells. I have read on this site that the Vaser technique completely destroys fat cells making it no good for fat transfer. Sorry for all the questions but my research has lead me to you and I think this procedure could produce the result I want but I want to be completely happy with the facts. Thanks for your time.

    1. Sorry correction, I have read on reviews on the 'real self' site.

    2. Hi gigi,
      good question, and something I looked into before starting this.
      VASER and Cytori (Puregraft) have done some viability studies to see what amount of cells remain viable after VASER. Fortunately it was good news and comparable to traditional liposuction if performed at lower intensity.
      It is well known that after any form of intervention there will be some loss of tissue - be it traditional lipo or VASER. This is because the tissue is kept out of the body for a short period of time and hence lacks oxygen and nutrients.
      Hope that reassures you.

  3. Dear Polly,
    Thank you for your commments/questions. It is very difficult to assess and comment on individual longterm outcome and retention. Every patient is different in genetics and has different variables/lifestyle etc.
    On average viability is around 50-80%. The ageing process also continues unfortunately and thus breast volume/size will reduce over time. The skin will also age. Not all patients present for their follow-up appointments beyond 12 months.
    This procedure is not a direct replacement for implant augmentation and the results achievable with autologous fat transfer are not directly comparable with implants.
    Hope that helps.
    Kind regards,
    Dr Wolf

  4. Is it possible to have my implants removed and fat transfer done at the same time? Thank you

  5. Dear Angie,
    Theoretically it is, but its not something I do. I prefer that they are done as separate procedures once everything has healed up.

    Kind regards,
    Dr Wolf

  6. Breast augmentation with fat transfer in Dubai is one of the most demanding technique to reshape the breasts without going through the saline or silicone bags or any other fake thing. The treatment adds shape to the breasts and increases fullness. The breasts augmentation with fat transfer Dubai clinic allows the patient to achieve a healthy look. The breasts lose their real shape due to several conditions and have serious deformation issues. There are several reasons for breast deformation such as hormonal change, breast cancer and environmental change.

  7. thanks for this usefull article, waiting for this article like this again. https://www.surgeongate.org