Imagine using your own fat, transferred from unwanted areas to enhance your breasts, or reconstruct them after mastectomy, congenital malformations or to correct asymmetry. This is now possible due to the new technique of micro-fat grafting.
Here are the most commonly asked questions about fat grafting.
Who is a suitable candidate for fat grafting?
Most people will have adequate fat stores in certain areas of their body to enhance their breasts, even if they are slender.
The best candidate for fat transplantation is someone who would like a natural looking soft breast, a subtle augmentation without large scars and does not like the idea of having breast implants. As well, people seeking liposuction can use the removed fat to augment their breasts or buttocks at the same time, without much further recovery time.
A small number of patients will be too thin to achieve reasonable results. If you feel you could be in this category, you are welcome to email some details of your weight and photographs for assessment of your suitability prior to booking a consultation to firstname.lastname@example.org
Does fat grafting last?
Current studies suggest with newer techniques of handling the fat, it will last provided a stable weight is maintained and there are no major hormonal changes.
Large changes in weight will affect the results as the breast fat graft behaves like fat in the rest of the body. Therefore if weight is gained post-surgery the fat grafted breasts will enlarge; if it is lost, the breast size will reduce.
If patients are planning to lose weight, this should be done prior to surgery.
There is no point gaining weight before surgery as in most people who maintain a relatively stable weight throughout their life, it is likely to gravitate back to the original weight post-surgery, and then volume will be lost from the breasts.
Is fat grafting safe?
Studies of large numbers of patients from around the world have shown there is no increase in the risk of breast cancer. You will be carefully monitored following surgery with MRI (Magnetic Resonance Imaging, a highly sensitive scan for detecting abnormalities in breast tissue).
A pre-operative screening MRI is required for all patients. This is read by a radiologist who is very experienced in reading breast MRIs. Follow up MRIs are required for screening to ensure no changes have developed in the breast. Scientific studies have shown it is easy to identify any concerning lumps in the breast compared to grafted fat. In fact, more abnormal areas are found after breast reduction surgery or breast lifting (a common procedure) compared with fat grafting. Here is a link to an article in a scientific peer-reviewed journal demonstrating this Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study.
Here is a link to the most recent publication on the safety of fat grafting showing no increased risk of breast cancer in a peer-reviewed journal, Plastic and Reconstructive Surgery.Lipofilling does not increase breast cancer recurrence risk
What are the advantages of fat grafting over other techniques?
-Small scars less than 1cm, usually hidden in body creases
-Feels completely natural
-Ability to reshape breasts that are constricted or tuberous (a congenital breast condition) with needle release (no scar technique)
-Ability to match asymmetry much more precisely than with implants if only one breast requires surgery
-Fast recovery (No specific exercise or movement restrictions; recovery is limited only by pain which varies from individual to individual)
-Bonus of liposuction which removes fat from unwanted areas
-No need for removal or exchange of devices down the track (an implant is not a lifetime device).
How does fat grafting work?
Fat transplantation techniques have significantly improved over the past decade due to more careful harvesting, handling and injection techniques for the fat.
It is centrifuged after removal, which means unnecessary fluid is removed, concentrating the fat to the most effective portion to inject. It is then injected through very fine cannulas into the breast and spread and layered in a very precise manner in micro-droplets to ensure all the fat cells have a good blood supply to survive.
Older techniques did not use these refinements, therefore in the past, the fat did not survive as well.
At the moment, studies show up to 75% and sometimes even more of grafted fat survives (so overcorrection is required). This has been confirmed with follow-up MRI studies of patients which demonstrate the fat does survive.
What is the recovery time after fat grafting?
Patients are up and walking the day of surgery. Most fat gratings can be performed as day surgery.
Dr Matousek works in conjuction with an anaesthetist who is focused on ensuring your post-operative pain is well controlled and minimal. Local anaesthetics are used in liposuctioned areas, and also in the breast which provides good pain control. General anaesthetic is the safest and most pain-free way of undergoing this type of surgery.
You will be required to wear a firm garment for 6 weeks following liposuction to minimise bruising and swelling. These are skin tight and can be worn under clothes without being very visible. These are also essential in giving you the best liposuction results.
There will only be very light dressings on the breasts where the cannula entry points for injection have been placed.
Bruising varies from patient to patient but should resolve in most by 2-3 weeks.
How many sessions will I need?
People wanting a very large augmentation or for breast reconstruction after mastectomy (especially those who have had radiotherapy) will need more than one session.
Also those who do not wish to wear the BRAVA (breast enhancement device) are likely to need more then one session unless they have very loose skin (common with previous pregnancy).
What is the BRAVA and will I need to wear one?
The BRAVA Breast Enhancement and Shaping System was invented by Dr Roger Khouri whom Dr Matousek has visited and learned this revolutionary technique
The BRAVA can increase breasts by one to two cup sizes. This is not maintained once the machine is no longer worn. However, it creates a big space for the transferred fat to be placed and also improves the blood supply to the transplanted fat.
This means wearing BRAVA reduces the number of fat grafting sessions needed (a tight non-expanded breast is limited in how much fat can be injected into it) and enhances survival of the transplanted fat.
The BRAVA is not essential for everyone. Dr Matousek will assess you at your consultation and recommend if the device will be of benefit for you. Equally good results can be achieved with multiple smaller sessions without the BRAVA device.
It is recommended for those wanting a large augmentation, those with a tight breast or those who have had radiotherapy.
Patients with loose breast skin (eg after multiple pregnancies), or those not wanting a large augmentation may not need to wear the BRAVA.
It needs to be worn for a minimum of 8 weeks before surgery (the total time depends on how many hours a day the person is able to wear it).
Visit http://www.mybrava.com/home.asp for more information.
Is this a stem cell graft?
New machines are available to select out stem cells from fat which is an exciting area of current research. Fat itself is a rich source of stem cells, and by centrifuging it, the amount of stem cells does increase in the injected fat. However, currently there insufficient evidence of the safety and efficacy of fat augmented with large numbers of stem cells by the use of devices. These are undergoing trials and although likely to be used in the future, this technology is new and has little published data. All the published clinical trials and safety data regarding fat grafting have been done on patients with centrifuged fat, not with stem cell augmented fat. The current method of fat grafting achieves very good results, without needing to do this.
Is fat grafting better than breast implants?
Dr Matousek still performs many breast augmentations with implants alone. Current breast implants have improved and are much softer and available in many shapes and sizes. These are still the best option for very slender people who simply do not have adequate fat stores. People wanting a very large size with one operation or those requiring a significant degree of breast lift may also be more suitable for implants.
How can a fat graft be beneficial in patients with breast implants?
Although some very thin patients may not have enough fat for a breast augmentation with fat transfer alone, they may have just enough to be injected into regions where the implant is visible. This can often occur in the cleavage area or upper part of the implant if there has been weight loss after surgery. It is also useful for implants that have been placed for breast reconstruction after mastectomy where there is little tissue coverage.
How can fat grafting be beneficial in revision breast augmentation surgery?
Dr Matousek specialises in revision breast augmentation surgery with a combination of fat grafting and implants. With each exchange of breast implants, there is a need to remove the capsule and in the presence of scarring and thinning of the tissues, fat can be beneficial in masking the visibility of implants and dealing with small asymmetries. Dr Matousek also recommends a special type of polyurethane-coated silicon implant in this situation which has a significantly lower rate of capsular contracture in the published literature.
Which is better for me; fat grafting or breast implants?
The advantage of seeing a surgeon who does both fat grafting and implants means that you can be given an outline of what is involved with either procedure and a recommendation as to which is the best choice for you. No technique is suitable for every single patient, and both implants and fat grafting have their risks and benefits.
I’ve been told fat grafting is dangerous and does not work.
There is much misinformation about fat grafting, particularly in Australia where the technique is not as widely practised as it is elsewhere in the world. Much of this comes from people who have little or no experience with the technique. There are now many published articles in scientific peer-reviewed journals supporting the safety and efficacy of this technique.
I do not live in Sydney and fat grafting is not available near where I live. Is it possible to arrange a consultation and surgery?
Dr Simone regularly has requests from interstate patients for consultations and surgery due to her extensive experience with fat grafting. Skype consults are an option as a preliminary way of assessing if you are suitable for the procedure. Click here for more information on how to arrange this. Organising a consultation and surgery for patients living outside Sydney.
Can I have fat grafting to other areas than the breast at the same time?
Fat grafting can be beneficial in other areas of the body, particularly the face. If you have used facial fillers in the past, fat is an alternative option. As it is your own tissue, in a lot of ways it is superior to synthetic fillers. Fat is good for replacing the volume loss that occurs with ageing or weight loss and this can be done at the same time as a larger volume fat graft without adding much operative time.