Breast enhancement with fat: pros and cons

May 2, 2008
American Society for Aesthetic Plastic Surgery (ASAPS)

It is the cosmetic treatment many women have dreamed of - taking the fat from their hips and thighs and redistributing it to their breasts. But many people question whether this procedure is safe or effective.

Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient's buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Lipoaugmentation of the breasts may offer patients permanent breast augmentation with a natural look and feel and the benefit of body contouring through liposuction - without the requirement for incisions or implants.

Sydney Coleman, M.D., a plastic surgeon in New York City, is a leader in the field of micro fat grafting to the face, which has become a major part of facial rejuvenation as it is practiced today. The technique has recently been extended to the breast and body where much larger amounts of fat are injected. "Breast shaping and augmentation with fat grafting provides a more natural aesthetic result for aesthetic and reconstructive patients. The placement of the fat grafts allows for dramatic or subtle shaping of the breast in a manner previously not attainable," said Dr. Coleman. "This type of shaping is extremely difficult or impossible with implants or surgery. The result is a natural appearing reshaped breast in which telltale signs of implants and surgery are absent - the resultant breast is completely fluid and natural appearing."

However, long-term safety and efficacy data, and the effect of the procedure on breast cancer screening using mammography, is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include typically low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring, as well as long-term problems with breast cancer detection due to difficulties distinguishing mammographically between calcifications associated with breast cancer and calcifications associated with fat transfer. This procedure offers mostly a one cup size enlargement and the degree of enlargement will depend on the amount of spare fat that the patient has.

Numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? Perhaps most importantly, what are the cancer implications of this technique?

"It is clear that autologous fat transfer around the breast or to create a breast is effective," said Scott Spear, M.D., a plastic surgeon from Washington, D.C., who is conducting a Georgetown University research project, funded by the Aesthetic Surgery Education and Research Foundation (ASERF), to determine the safety and efficacy of breast enhancement with fat. "However, what still needs to be determined are the more intricate details - technique and placement of the fat tissue, who should receive this transfer, when it is appropriate, and whether it is safe to be done at all."

"Breast enhancement with fat is still a relatively new technique, and we continue to evaluate this procedure. We are still collecting long-term safety and efficacy data. However, results from a recent study by Roger Khouri, M.D., and colleagues appear very promising with four years of follow up," said Jack Fisher, M.D., a plastic surgeon with a practice in Nashville, Tenn.

Dr. Khouri, who developed the BRAVA external breast expansion system and is now involved in a clinical trial combining the BRAVA system with fat grafting, will also be presenting results from a recent study as part of the panel discussion.

"Lipoaugmentation of the breast allows us to shape the breast and obtain beautiful, permanent augmentations. However, it is crucial to warn the public that the procedure is very technique dependent," said Dr. Khouri a plastic surgeon in Key Biscayne, Fla. "To avoid complications it has to be done right by properly trained plastic surgeons."