If only we could take fat from where we DON’T want it and put it where we do.
This is the premise behind fat grafting to the breast. Lipoaugmentation, fat transfer to the breast, fat grafting are all terms you will hear. Your own fat is a wonderful substance. It is soft, part of you, not a foreign object with issues of body rejection. So what is the story? Why do we do breast augmentations with silicone and saline implants at all?
Fat grafting is not a new technique. We plastic surgeons have been doing fat grafting for years. The techniques have been refined over the years to try to increase fat survival. When you move fat from one area (your inner thigh) and put it in another area (your buttock, breast, etc), the fat must recruit a new blood supply to live. Fat cells are living cells. They need blood to bring oxygen and nutrients so they can live. The newer fat grafting techniques involve harvesting the fat with less trauma, to preserve the health of the fat cell, and placing the fat cells in the new area by smaller injection sizes to improve the blood flow to the newly moved fat cell.
Imagine you are laying new grass in your backyard. You created a fertile, rich soil bed. It is moist. But there is no lawn sprinkler system yet. You have to wait a week until that will hook up to feed your new grass. If you lay down grass by rolls of sod in a low water environment, it will have a hard time surviving. If instead you tried to grow the grass in a low water state with individual seeds, you will have more of your product survive.
What does fat do if it dies? Ahhh. Here’s the rub. If fat dies, it does two things which are not good for breasts. First, the fat can harden. Second, the fat can calcify. The second point is the one which prevents most plastic surgeons from doing large scale fat grafting to the breast: what do we do about calcifications? Mammograms are based on finding clusters of calcifications to detect breast cancer early. What do we do for a 40 year old patient who had breast augmentation with fat years ago who now has calcifications throughout the breast?
There is also the issue of how much fat survives. If the fat does not get a blood supply, in addition to turning hard (fat necrosis) and calcifying, it can just melt away. This is the “take” of the fat graft. To compensate for this, many will fat graft more fat than they think they need, assuming some will melt away. Others will do a series of grafting to add more as needed. And even if the fat has good take, it is not unusual to see the fat gradually lessen in volume over time.
I am a natural girl. I have had three kids and know firsthand how fat goes from where you do want it (breast) to where you don’t want it (everywhere else). I think fat is a wonderful graft substance in other areas of the body: cheek, lip, back of the hands, indents and divets on the body. But the breasts are a unique place. Breast cancer rates used to be quoted as 1 in 11 when I was in med school. Now they quote 1 in 6.
This is a hot topic for us plastic surgeons. We want to use natural substances to do breast augmentation. There are currently studies being done to specifically look at our issues: how much fat can be grafted at a time? Will we be able to increase breast size by one cup ? more? What are the changes seen after fat grafting to the breast on serial mammograms? Does the breast hold the change in volume?
Until these are better studied, hold onto that fat and don’t put it in your breast quite yet.