[:en]Fat has become an increasingly popular injectable.  For many of us, it’s in abundance, it’s natural, and it’s soft.  Plastic surgeons do use fat in many parts of the body for both cosmetic and reconstructive purposes, including filling in contour defects after breast reconstruction or liposuction, and to plump deep folds in the face.  The use of your own fat for augmentation of the breast is an attractive idea in theory; take something (fat) from an area where you don’t want it (your hips, thighs, buttocks…), and put it somewhere that you do want it (the breasts).  However, the use of fat for injection for breast augmentation has been a highly controversial topic among plastic surgeons for decades.

This topic is controversial for several reasons.  First, grafting fat to the breast can result in nodules and calcifications in the breasts, which can interfere with breast cancer screening and imaging.  Despite this, there is no data to date which shows a clear interference with the detection of breast cancer.  A second issue concerns the potential for mature fat cells and fat-derived stem cells to favor the growth of breast cancer.  However, this data is also limited, and in fact some studies show that adipose-derived stem cells can actually inhibit the spread of breast cancer.  Some of the known complications associated with fat grafting include infection, cyst formation, fat necrosis, fat resorption, nodule formation, and calcification formation.  The methods that surgeons use for harvesting the fat, preparing it, and injecting it also vary widely.  However, each of these items determines how successful the graft will be in terms of its long-term outcome.

Breast augmentation with implants and fat grafting to the breast for volume enhancement are not equal procedures.  While implants provide a predictable result with a fixed volume, fat grafting may require several procedures with a less than predictable result.  Fat grafting is also more expensive as a result of the need for several procedures.  Of course, implants aren’t perfect either; this is a medical device which is placed in the body for purely elective reasons, and it will not last forever.  Each procedure has its own set of risks and benefits.

At this time I do not offer fat grafting for primary breast augmentation, based upon the current data.  However, I do use it in selected cases for adding volume to small areas following breast reconstruction and tuberous breast procedures.  Nonetheless, the technology is developing rapidly in this field, and numerous studies are being conducted on the benefits of fat grafting.  I look forward to further refinements in this area that will hopefully allow us one day to offer this treatment to all patients.

¹Rosing JH, Wong G, Wong MS, Sahar D, Stevenson TR, Pu LLQ.  Autologous fat grafting for primary breast augmentation: A systematic review.  Aesth Plast Surg 2011; 35: 882-890.[:fr] 

Fat has become an increasingly popular injectable.  For many of us, it’s in abundance, it’s natural, and it’s soft.  Plastic surgeons do use fat in many parts of the body for both cosmetic and reconstructive purposes, including filling in contour defects after breast reconstruction or liposuction, and to plump deep folds in the face.  The use of your own fat for augmentation of the breast is an attractive idea in theory; take something (fat) from an area where you don’t want it (your hips, thighs, buttocks…), and put it somewhere that you do want it (the breasts).  However, the use of fat for injection for breast augmentation has been a highly controversial topic among plastic surgeons for decades.

This topic is controversial for several reasons.  First, grafting fat to the breast can result in nodules and calcifications in the breasts, which can interfere with breast cancer screening and imaging.  Despite this, there is no data to date which shows a clear interference with the detection of breast cancer.  A second issue concerns the potential for mature fat cells and fat-derived stem cells to favor the growth of breast cancer.  However, this data is also limited, and in fact some studies show that adipose-derived stem cells can actually inhibit the spread of breast cancer.  Some of the known complications associated with fat grafting include infection, cyst formation, fat necrosis, fat resorption, nodule formation, and calcification formation.  The methods that surgeons use for harvesting the fat, preparing it, and injecting it also vary widely.  However, each of these items determines how successful the graft will be in terms of its long-term outcome.

Breast augmentation with implants and fat grafting to the breast for volume enhancement are not equal procedures.  While implants provide a predictable result with a fixed volume, fat grafting may require several procedures with a less than predictable result.  Fat grafting is also more expensive as a result of the need for several procedures.  Of course, implants aren’t perfect either; this is a medical device which is placed in the body for purely elective reasons, and it will not last forever.  Each procedure has its own set of risks and benefits.

At this time I do not offer fat grafting for primary breast augmentation, based upon the current data.  However, I do use it in selected cases for adding volume to small areas following breast reconstruction and tuberous breast procedures.  Nonetheless, the technology is developing rapidly in this field, and numerous studies are being conducted on the benefits of fat grafting.  I look forward to further refinements in this area that will hopefully allow us one day to offer this treatment to all patients.

¹Rosing JH, Wong G, Wong MS, Sahar D, Stevenson TR, Pu LLQ.  Autologous fat grafting for primary breast augmentation: A systematic review.  Aesth Plast Surg 2011; 35: 882-890.

 

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