Overview

Many patients desire to improve the appearance of their breasts but are apprehensive about seeming too phony or about traditional breast implants. Recent advancements in breast augmentation, on the other hand, allow doctors to use your own body fat to expand your bust size and elevate your breasts. This is referred to as fat grafting. Patients also like the improved appearance and feel of their natural breasts, as well as the added benefit of increasing the body's curves.

 

What is Fat grafting?

Fat grafting, commonly known as autologous fat transfer, is gaining popularity as a new breast reconstruction technique. Liposuction is used to remove fat tissue from other parts of your body, mainly your thighs, abdomen, and buttocks, for fat grafting. To reconstruct the breast, the tissue is converted into a liquid and injected into the area. Lipofilling, a type of fat grafting, has been performed for many years to correct minor discrepancies in the contour, balance, or location of the reconstructed breast compared to the other breast.

Because that worked so well, experts speculated that they could be able to recreate an entire breast using fat. Because fat grafting does not require significant surgery, it may be tempting to consider it a "safe" operation. However, we don't know how successful it will be in the long run. Because fat grafting is so new, no substantial clinical trials have been conducted. The trials conducted thus far have involved less than 100 women, with an average follow-up time of less than four years. It's also vital to understand that fat injected into the breast area may be reabsorbed by the body over time, causing the breast to lose volume.

 

This is why some plastic surgeons may first add more fat than you believe you require. Furthermore, if fat grafting fails and you elect to employ a flap restoration, you may have already depleted an essential source of tissue, such as the abdomen. All of this should be kept in mind. An external tissue expander known as a Brava device is worn for several weeks before and after fat grafting in one type of treatment. The Brava device resembles a bra with plastic cone cups. The cones use suction to expand the tissue and create a matrix for the fat to reside in.

Wearing the Brava device appears to be critical for maintaining the volume of the reconstructed breast. In one study, women who did not use the Brava device as recommended saw their breast volume drop nearly twice as much as those who did. Depending on the size of your reconstructed breast, you may require repeated fat grafting treatments over a period of months, usually under general anesthesia.

 

Fat Grafting and Weight Loss

There has also been minimal investigation into how weight loss and growth affect transferred fat and how it settles in the breasts. Many surgeons are concerned that removing fat from a place where primary weight gain occurs, such as the stomach, would result in continued breast growth if those fat cells are used.

 

What is the history of Breast Fat Grafting?

Fat grafting is a safe operation that has been used for decades. It's worth noting that the concept of fat grafting stretches back over a century. A German physician first discussed fat grafting in 1893, when he transferred upper arm fat to the face. Another doctor conducted breast augmentation surgery in 1895 by moving a lipoma (fatty tissue deposit) from the back to the breast.

Since then, fat grafting procedures have advanced and refined to the point where it is now a standard method for restoring or enhancing breast volume. Breast fat grafting has been a common treatment for addressing contour defects in the breast (even after breast cancer removal), and it is also gaining acceptance as a major method for breast augmentation due to its potential benefits.

 

The benefits and risks of fat grafting

Breast augmentation can improve breast size and shape while also correcting asymmetry. Structural fat grafting, in particular, has the ability to raise sagging breasts, restore shape, and even conceal existing implants.

Other benefits of structural fat grafting for breast augmentation include:

• A more natural procedure. Instead of using saline or silicone, this method takes fat from your own body. It prevents rejection and leaves less scarring.
• A longer-lasting result. While other implants may need replacement over time, fat transfer is permanent.
• A more pleasing body overall. Structural fat grafting uses fat from other parts of your body to trim down those areas.
• Better shaping. Unlike implants, which have limited alternatives, structural fat grafting allows your surgeon to create a unique look for you.
• Minimal incisions and scarring.

The disadvantages of fat grafting are: 

• There have been no big clinical studies with long-term follow-up on fat grafting; while tiny studies show favorable results, we don't know if this treatment will work for all women or how long the results will stay.
• Depending on the surgeon you pick, you may be needed to wear the Brava device or another type of external tissue expander for 4 or more weeks prior to the fat injections and for several weeks afterwards.
• It may require 4 to 6 individual sessions to get the best potential results. 
• The injected fat may be reabsorbed by the body and you may lose some or all of the breast volume over time. 
• Because some fat cells can encourage cell growth, some doctors are afraid that fat injected into the breast area will cause dormant breast cancer cells to proliferate; further research is required to determine whether this is true.
• Some of the fat injected into the breast area may die, a condition known as "necrosis." Necrosis symptoms include pain and bleeding, the skin turning dark blue or black, numbness, fever, and sores that ooze a foul-smelling discharge or pus. 
•  If fat grafting fails, you may exhaust a key tissue source for a future flap reconstruction.
  
  
  

Who is a good candidate for fat grafting to the breast?

Natural augmentation with fat grafting produces quite different results than breast augmentation with implants. Fat can only provide mild breast augmentation and form improvement.

Injecting fat into this location will provide greater fullness for patients who complain of gapping at the top of their bra. It will help them fill out their bra size but will not affect their bra size.

 

Recovery from Fat Grafting

Your recovery after structural fat grafting is primarily determined by the number of donor sites employed by your doctor. For at least a week, you should expect bruising and swelling in those regions. Your breasts may be bruised and swollen, but you should feel little or no pain. Soreness can linger for up to two weeks after surgery.

You might be back at work in about a week. Most bruising and swelling should resolve within three weeks, but mild swelling may last up to six months.

You should walk as much as possible the day after surgery and be able to resume gentle activity in 10 to two weeks. You should not apply pressure on your breasts. Sleep on your back and avoid heavy lifting or upper-body exercise.

 

Anticipated Results

Each surgery can enhance your breasts by one cup size on average. Any greater expansion would typically necessitate additional surgeries.

Traditional implants, which may require repair over time, may not survive as long as structural fat grafting. While fat is a delicate tissue, the structural fat grafting procedure injects fat to provide it with a blood supply, allowing it to endure longer. Whatever growth remains after four months of healing will be permanent.

The process also allows the surgeon to sculpt your breasts more easily than silicone or saline implants.

 

Myths About Fat Grafting

There are numerous myths surrounding fat grafting to the breast. I perform a lot of fat grafting surgeries, and I hear about them all the time in my practice. So, let's go over some myths and try to dispel them:

   1. MYTH: Fat will disappear.

Fat grafting necessitates a harvest from another site, followed by processing and injection. Some fat cells may be destroyed during the operation. Even though the goal is to remove all fluids (injected to reduce pain and bleeding), blood, and non-viable fat cells, some will be injected. Furthermore, even completely healthy fat cells in the breast will not receive adequate blood flow.

As a result, not all of the volume injected is actually healthy fat cells with adequate blood supply. What isn't absorbed by your body is the good fat that did survive. You will also experience edema as a result of the operation, which will take time to resolve. However, the fat that you have after a few months is likely to be permanent. However, as your weight fluctuates, so will the size of your breasts.

   2. MYTH: Fat grafting is an easy surgery.

Although fat grafting has several advantages over implants, it is a more time-consuming and technically demanding surgery. Every step of the method must be precisely completed, or the fat survival rate will suffer. It takes time and requires a lot of patience on your surgeon's behalf. Not all surgeons have the patience required to get the desired outcome. The outcome will be limited if they are unwilling to place the fat drop-by-drop.

   3. MYTH: Fat cannot increase the size of the breast very much.

Because blood flow is so important, you can effectively double the size of the breast during surgery. If you exceed that quantity, the fat will not have adequate blood flow and may die. You can expect a 50-60% larger breast than before surgery after fluid resorption and swelling has stopped. If you have a second surgery, you can inject more than the first time, leaving your total volume 2-2.5x larger than when you started if all goes well.

   4. MYTH: Fat grafting and implants are never done together.

Fat grafting is a fantastic procedure that can be used in conjunction with an implant. Although many individuals do not require it, it can effectively cover the edge of an implant in thinner patients. This gives patients a full, yet natural-looking and feeling, outcome. It is also excellent for improving cleavage in people with wide set breasts. However, relatively few surgeons do this procedure. It is only performed by surgeons who have a strong interest in both breast surgery and fat transfer.

   5. MYTH: Fat will leave me with lumps or dents.

Fat grafting can produce stunning effects that appear and feel completely natural. However, the procedure must be carried out with great care. If you place too much fat or perform it incorrectly, you will have a significantly higher likelihood of fat loss or oil cysts. You must consult with a surgeon who specializes in fat transfer. Not all surgeons achieve excellent results with fat transfer. It is not as simple as inserting an implant.

   6. MYTH: Fat transfer is better than implants.

There is no such thing as a perfect surgery. plastic surgeons spend a lot of time with my patients across numerous appointments, guiding them to the optimal solution for them. Fat transfer is advantageous since there are almost no scars, you can treat a "problem" area with liposuction, and the results are quite natural. It does not, however, work as effectively to enhance volume when you want a significantly larger breast. It also does not improve the form of the breast as well as an implant in someone who already has a less attractive shape. Your surgeon should go over all of your options with you and help you decide which is best for you.

   7. MYTH: Fat grafting can be done in anyone.

While fat grafting can be performed on everyone, not everyone is a good candidate. To make it worthwhile, you must have enough fat to harvest. The only fat people have is in their butts. Not every patient wants to lose volume in their buttocks. You'll also need a location to put it. If you are so thin that there is limited room for the fat to be placed, you may require more than one surgery.

Remember that you can double the size of your breast during surgery, making you 50%-60% larger in the end. A second procedure can remove significantly more fat than the first, leaving you up to 2-2.5 times larger than when you started. Some people may merely benefit from an implant and some fat grafting to conceal it well.

   8. MYTH: There is only one perfect technique.

Remember that you can double the size of your breast during surgery, making you 50%-60% larger in the end. A second procedure can remove significantly more fat than the first, leaving you up to 2-2.5 times larger than when you started. Some people may merely benefit from an implant and some fat grafting to conceal it well.

   9. MYTH: Fat transfer costs more than implants.

Fat transfer is heavily reliant on the amount of time it takes to harvest, prepare, and transfer the fat. It takes considerably longer than an implant. As a result, surgery and anaesthetic fees will rise. However, there is no significant expense for implants. Finally, the prices aren't that different. Based on your objectives, select the appropriate surgery for you. Not the price.

   10. MYTH: Fat transfer is a cosmetic procedure.

Fat transfer has been utilized in aesthetic and reconstructive surgery for a long time, but it has recently become considerably more popular. I use it in a variety of situations. For cosmetic purposes, plastic surgeons use it in breast augmentation to increase size; in breast lift to increase fullness in the upper breast without using an implant or when a patient doesn't want to be too much larger; to create better cleavage during breast augmentation or breast lift surgery; to soften the contours of prominent ribs; and to conceal a breast implant in a thin patient (without having to lift up the muscle).

Plastic surgeons use it for breast reconstruction for nearly all of the reasons I just mentioned, but also to conceal the edge of the breast reconstruction (whether a flap of tissue or implant); to fix lumpectomy defects; to improve the quality of radiated tissue, prior or after breast reconstruction; and, in some cases, to create an entirely new breast from transferred fat.

 

Complications with Fat Grafting

Many surgeons are particularly concerned about volume loss, cysts, skin retractions, and what happens to grafts as you gain weight. Furthermore, many surgeons and patients agree that transferred fat does not feel as natural. When compared to saline or silicone implants, fat grafts may feel harsher.

Furthermore, while fat is natural, it is also an impediment. Natural substances perish, and fat grafting has the potential for necrosis and the formation of hard nodules. Natural fat can also contribute to volume reduction. Although studies have indicated that 30-50% of fat will survive, it is impossible to predict how this will effect the breast augmentation process.

 

Fat Grafting or Breast Implants – Which Looks and Feels More Natural?

Patients undergoing breast augmentation can now choose between saline, silicone, and fat grafting for their plastic surgery procedures. However, each alternative has its own set of problems and restrictions.

Many aspects must be considered before deciding on the best sort of surgery. Over the years, silicone and saline implants have been utilized numerous times in breast augmentation surgeries. These are tried-and-true classics that are still in use today. As a result, the choice employed in your operation is frequently fully determined by what you and your surgeon agree provides the greatest results.

 

Conclusion 

Fat grafting can produce a natural-looking, long-lasting outcome with minimum incisions and scarring. During the operation, your doctor will use liposuction to remove fat from one or more places of your body and redistribute it to your breasts. Breast fat grafting can also be utilized to improve and optimize the outcomes of breast augmentation or breast lift surgery.