I get asked this question a lot.
People think when I say I am not doing fat grafting to the breast yet that I don’t know how to fat graft. Pshaw. I have done a lot of fat grafting: cheeks to fill the under eye and cheek hollow; hands to give some padding to hide the bony and veiny look; buttocks to try to give some lift and fullness; liposuction patients who have dents or irregularities that need to be fixed.
So what is the big deal with breasts?
1. Calcifications. If fat doesn’t “take” it calcifies. “Take” is a fancy way of saying when you move fat to a new place that it gets a blood supply and lives. Like a new plant you put into the dirt in your backyard, when you move a living thing from one place to another, it needs to set down roots and get its nutrition and water in the new place. With fat, if it doesn’t get a new good blood supply, it dies and can calcify. I don’t care if you have a few calcifications in your cheek or hand or bottom. You usually can’t see or feel them. But I do in the breast. Calcifications are exactly what mammograms are looking for to detect cancer.
2. Volume. When patients come in for breast augmentation, we try on sizers. A lot. And you try on different kinds of tops. Look in the mirror. Show your friends. Do the rice test. Stuff your bra for a while… Size is very important when it comes to augmentation. I find most women have a narrow range where they go from liking the size to not liking it.
So when we do fat grafting we assume not all of the fat will live. Just like if you seed a lawn, you don’t expect every little seed will turn into a blade of grass. So how much will I lose? If I graft 500cc of fat, will 300cc live? 250 cc? 450cc? It is a big difference. I think we will err on a hair too much- we can always liposuction it away, but ideally we want to be as spot on as we can be.
3. Changes with time. All of us who have done fat grafting know sometimes it seems to stay forever, and sometimes it seems to slowly dwindle over time.
You can’t assess true fat take at one month after surgery. At one month you will still have swelling and other things which may make it look like more fat has taken than really has. You really need to evaluate your results at 6 months out from surgery. That being said, I have seen patients with great results at 6 months, who at 2 years look like they lost some more. This has given rise to some calling fat grafting “semi permanent.”
Why the late fat loss? Unclear, but some of this loss may have to do with technique. Again, I defer to my colleagues who lecture on this topic, as they have longer experience and studied and published on the matter. I will use some of their tricks to aid my patients.
The biggest reason though is those calcifications. For any woman who has had a mammogram and been called because “there is something we need to take a better look at. Can you come back in?….” We need to avoid that if we can.