Fat Grafting: 2006

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Fat Grafting: 2006
Fat Grafting: 2008
High Riding Implants
History of Breast Implants

by Peter T. Pacik, MD, FACS

You could have knocked me over with a feather! At the recent annual meeting of the American Society of Aesthetic Plastic Surgery (Orlando, April 20-26, 2006), the twenty-year ban of fat grafting the breast was challenged by two studies. One paper titled “Breast Augmentation with Autologous Fat: Time to Revisit the Ban” studied 22 women who underwent 25 fat grafting procedures on 48 breasts. Baseline MRI studies preceded the fat grafting procedures. In addition, pre-op breast expansion was done using the Brava external breast tissue expander to promote increased blood supply to that area. Fat was injected mostly below the skin. The average augmentation volume was 170cc and ranged from 90cc to 200cc. Graft survival averaged 90% (range 70 to 100 percent). Follow-up MRI’s were done at 3 months post-op and again at 6 months at which time a mammogram was also done.

The importance of this study is to question the validity of the long-term ban on fat grafting the breast. It was originally thought that fat grafts that did not survive and would calcify, thus interfering with mammography for cancer screening. (Micro calcifications are an important diagnostic tool for radiologists to help diagnose early breast cancer.)

In this study, increased calcification was noted when fat was injected into the gland itself, and the authors therefore recommend that this approach be avoided. Fat injected into the fatty layers below the skin (subcutaneous fat) showed little to no calcification and less than the calcification that would be seen after breast reduction (reduction mammaplasty).

At the time of this writing (May 1, 2006), it is too soon to know how the Plastic Surgery Society will respond to this study. Until we get approval for this, and additional guidelines regarding technical factors, it would be best to avoid doing this at the present time. Fat grafting of the breasts for breast enlargement may give women additional choices in the future. Augmentation Mammaplasty performed by fat grafting takes considerably more time than the insertion of a breast implant. The injected volume is somewhat limited by the amount of fat that can be harvested, and the amount of fat that can be safely injected. Too much fat injected may not survive because of a limitation of the blood supply.

I feel that this is a landmark study, performed by experienced surgeons, which may very well challenge our preconceived notions about fat grafting the breasts.

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