Fat transfer to the breast for breast enlargement (cosmetic or reconstruction after cancer) is a growing field in plastic surgery. You can read all of my blogs and posts on the subject here. One of the big concerns about fat transfer to the breast is calcifications. The worry is not big large hard calcification lumps- as I am sure most plastic surgeons are doing as I do, using microfat transfer where we do tens to hundreds of passes with small aliquots of fat– but the worry is small tiny calcifications called “microcalcifications.”
If you can’t feel the calcifications then why do you care? You do in the breast because microcalcifications are what radiologists are looking for on your mammogram. So if you transfer fat to the breast and it can form microcalcifications are you making it impossible to detect what is fat grafting and what is breast cancer?
Those who do a lot of fat grafting and fat transfer for breast augmentation would argue you can tell the difference.
- there are not as many calcifications as there were in the past due to better techniques: smaller fat globule harvest size, BRAVA system to help prepare the breast and fat survival after, micro fat grafting in small amounts, multiple injection sites, and centrifuging the fat.
- the calcification pattern is different for fat transfer than it is for cancer: in breast cancer you see a cluster of calcifications, not a random pattern
- any breast surgery can cause calcifications, so why are we singling out fat transfer as a problem?
In this study featured in the May 2012 Plastic and Reconstructive Surgery Journal, “Mammographic Changes after Fat Transfer to the Breast compared with Changes after Breast Reduction: A Blinded Study”, radiologists compared pre and post breast surgery mammograms between two groups of patients. One group had autologous fat transfer to the breast, the other had breast reduction. The question was which group had more changes after breast surgery? Was it the fat grafting women or the breast reduction women?
Findings?
- 50 mammograms were assessed by8 radiologists, for a total of 400 images read
- The follow up mammogram was done 1 year after surgery
- The average total fat volume injected was 526cc
- Scarring, benign calcifications, and masses warranting biopsy were all significantly less common in the fat grafting patients
- biopsy and 6 month follow up rates were higher for breast reduction patients (meaning they saw an abnormality which required biopsy or a sooner follow up than the traditional one year)
The commentary discussion page by Dr. Spear which followed said the study was well designed. He stated it may not be an ideal comparison, as Japanese women undergoing reduction are a different type of patient and breast than the breast reduction patient in the US. Also, Dr. Spear states he is unsure breast reduction should be the control group when trying to assess mammogram changes. He also commented on the differences between the ability of the radiologists to read mammograms.
Regardless, the study is good in showing procedures which are not controversial (ie the breast reduction, which has been done in large numbers for decades) cause mammographic changes, and the changes seen in fat transfer patients are not different in nature from breast reduction patients (and it even indicates there may be fewer changes with the fat transfer patients).