Are you considering breast augmentation or reconstruction?
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There’s a new alternative to implants that uses your own fat cells to enhance breast tissue. It’s called fat grafting, and while it is an involved process of multiple injection procedures, the end result does not involve any surgery or scarring.
Many patients are good candidates for fat grafting, but it won’t work for everyone. Also, the number of operations needed for the process varies by individual. On average, a full mastectomy reconstruction requires up to five surgeries with between 300 and 400 ml of fat injected per session, says plastic surgeon Raymond Isakov, MD.
Your surgeon will help you decide whether it’s an option, and if so, how many operations you would need. Doctors assess each case on an individual basis, and results aren’t guaranteed.
Dr. Isakov says the procedure is currently targeted toward women. However, the theory behind it would work equally well in men, so it is an option for transgender patients.
Step 1: Tissue expansion
First, depending on a patient’s anatomy and whether her doctor recommends it, a woman may wear a tissue-expansion device to prepare for successful fat grafting in the breasts.
There is a large, suctioning device called Brava® that fits over the breasts like a bra. It’s battery-powered and gently puts tension on the breasts, stretching the tissue and preparing it for upcoming procedures.
The theory is that the gentle, sustained tension prepares the area for fat grafting, maximizing survival of the grafted fat.
“The device creates a negative pressure or vacuum that helps increase blood supply to the area where fat is injected,” Dr. Isakov says. It also softens the surrounding tissues to accommodate more transferred fat.
Although there isn’t a specific, prescribed way to use the device, Dr. Isakov recommends wearing it for at least two weeks both before and after the procedure, for at least 12 hours a day.
“I don’t recommend this for everyone,” he says. “There are trade-offs – a patient must be compliant and have the right anatomy. It isn’t the standard of care at this point, but it is an additional available technique.”
Step 2: Fat grafting
Once the tissue is prepared to make a fat transfer more viable, a plastic surgeon harvests a patient’s fat via liposuction or contouring. Next, oil and blood are removed from the fat. The surgeon then injects small amounts in tissues throughout the breast area.
Surgeons take care to ensure that the transferred fat has a good blood supply. Without it, the fat won’t stay in place and the patient won’t get the desired long-term effect. Also, if doctors transfer too much fat at one time, it’s possible for the fat to die and liquefy, turning into an oil cyst that sits beneath the skin and causes inflammation.
If successful, the fat-transfer process offers permanent results without implants.
Future mammograms do not seem to be a problem. Radiologists can tell the difference on the images between the repositioned fat cells and any potential calcifications that might be cancerous, Dr. Isakov says.
In a traditional breast implant procedure, the surgeon inserts a pre-made implant in one operation that, typically, lasts under an hour. In contrast, fat grafting requires multiple operations – sometimes as many as five – and can last for two or three hours at a time, Dr. Isakov says. The surgeon injects a limited amount of fat during each visit.
Risks and limitations
Even though the fat-transfer process uses a patient’s own fat cells, it won’t work for everyone. Surgeons must harvest fat in a thoughtful manner, Dr. Isakov says.
Common limitations include:
- Not enough fat: In many cases, thin people don’t have enough fat reserves to support the fat-transfer technique. Harvesting fat too aggressively can lead to complications from liposuction, such as dimpling. “It’s my opinion that if someone is too thin then they’re not a great candidate,” Dr. Isakov says. “If you harvest too much fat, you can create cosmetic abnormalities.”
- Skin is too tight or too loose: A patient’s skin can either be too tight or too loose for the procedure to work successfully. Only an individual consultation with a board-certified plastic surgeon familiar with fat grafting can determine whether a patient’s skin can handle undergoing these procedures, Dr. Isakov says. Consequently, it’s impossible to pick and predict an ultimate cup size.
- Insufficient blood supply: Insufficient blood supply can also be a limitation. As mentioned, the transferred fat won’t maintain its position of viability without access to a healthy supply of blood.
“Fat grafting isn’t for everyone. This is something a plastic surgeon and patient must discuss together after looking at the patient’s anatomy,” Dr. Isakov says. “They must look at the chest and donor sites and, then, consider the patient’s willingness to be compliant. They then can decide together on the best plan.”
Another limiting factor? Lack of insurance coverage. Currently, many insurance companies don’t cover the fat-grafting technique because they still consider it experimental. Also, insurance companies do not cover cosmetic procedures.