November 2, 2009
One of the hottest topics in breast enhancement today is the use of autologous fat. Before breast implants were even a thought, many surgeons were using their patient’s own fat to replace loss facial volume. But even then, they realized that with precise technique and painstaking placement, fat was not always predictable and that even though the initial results may have looked good, they didn’t always stay that way over time. Since then, the science of fat grafting (AFG) has been advanced dramatically and we understand better how to achieve more durable results.
And so it is not surprising that fat grafting would eventually make its way to breast enhancement. Since many of us have a little extra fat here and there, surgeons put two and two together and realized that breasts could potentially be volumized simply by taking fat from another place and injecting it into a woman’s breasts. And so the media caught on and results were shown of beautiful breasts made more beautiful simply by adding fat. But its’ not that simple.
The American Society of Plastic Surgeons (ASPS) banned the use of fat grafting for cosmetic augmentation in 1987 but recently revisited its use by conducting a study to evaluate just how safe it actually is to use fat for breast augmentation. The concerns range from slight imperfections (due to local fat necrosis) to severe infections and potentially induction of breast cancer. Although Plastic Surgeons have used fat to reconstruct breasts after mastectomy, in this case all breast tissue is removed before the fat is actually added. And so fat, which excretes estrogen (a hormone that stimulates breast cell growth) has very little risk of stimulating breast cancer cells. But in the case of cosmetic augmentation, breast tissue obviously still remains and so there is a theoretical risk, albeit small, of increasing the risk of breast cancer. The current study, although not large (50 patients) to date has not shown an increased risk but nevertheless the risk potentially still remains.
And so the question is asked, will fat transfer ultimately replace the need for breast implants and is it a safer alternative to the saline or silicone gel implants currently being used. To best answer this, keep in mind some potential advantages and disadvantages.
Fat Is Readily Available
- Advantage: there is no implant cost
- Disadvantage: fat can be unpredictable and the procedure may need to be repeated to achieve long-lasting durable results whereas with an implant the volume is known
Fat Is Your Own Tissue
- Advantage: there is no chance for rejection
- Disadvantage: numerous studies have documented the safety of breast implants and their results are predictable
Cost
- Advantage: liposuction is performed at the same time and so you are getting two procedures at the same time
- Disadvantage: most surgeons currently performing AFG for breast augmentation are charging significantly more for this procedure than for a conventional implant breast augmentation (many times the cost may run upwards of $10,000 or more!)
The Technology For Fat Grafting is Becoming More Refined
- Advantage: better fat survival is being seen and the results are potentially more predictable than they were previously
- Disadvantages: aside from a few highly trained specialists, many Plastic Surgeons are not actually trained to use fat for breast augmentation and so the risk for complications can be very high. A recent study in the Journal of Plastic & Reconstructive Surgery documented just how dramatic these complications may be and warned of these dangers.
And so what is the consensus? Most Plastic Surgeons are still very wary to fully embrace fat grafting for breast augmentation until the process is more adequately refined and until the question of breast cancer stimulation is satisfactorily answered.
If you have any questions about this interesting topic, please do not hesitate to contact me or my staff. We look forward to your input.
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