Fat Transfer Breast Enhancement

The results of a natural breast augmentation with fat transfer are often referred to as semi-permanent or lifelong. Immediately after the procedure, the injected fat cells will begin to settle into their new location, where they will take up permanent residence. However, not every fat cell will survive the transfer, so surgeons routinely inject more fat cells than needed at the time of transfer. The entire settling process will take approximately six months to complete and for the final results of the procedure to be fully appreciated.

Once the fat cells have established residence within the new breast tissue, they will remain active for the life of the patient. However, since they are living fat cells, they will respond to fluctuations in weight by either shrinking with weight loss or enlarging with weight gain. While the amount of fat after a fat transfer procedure remains stable with up to a 10% weight gain or loss, greater weight alterations can impact breast size.

With significant weight loss, the fat cells can shrink, resulting in a loss in breast tissue size and an increased risk of the breasts developing a sagging or deflated appearance. On the other hand, a significant weight gain can increase breast size, which can increase the risk of a droopy appearance. These changes result from the skin not having enough time to adjust to the new size of the breast and may not have the elasticity needed to accommodate the alteration in breast size due to weight changes.

Fat transfer is an excellent option to help “fill” saggy breast envelopes following breast implant removal. In fact this is the most common application of fat transfer that Dr Pautler uses, more than in the face or the buttock.

Fat transfer breast augmentation can be used to gain one to one and a half cup sizes. If a greater enhancement is desired, additional fat grafting procedures can be done, or breast implants are typically used as they provide a more reliable means to provide a size increase of two or more cups. 

The main limiting factors in increasing breast size with a fat transfer breast augmentation are:

• The amount of fat available for transfer
• The percentage of fat cell survival after the transfer  
• The recipient site capacity (small breasts with a tight envelope will only accommodate a certain amount of new fat cells whereas a large stretched out flabby breast envelope may accommodate more fat cells. Also there is a finite amount of blood supply for the transferred fat cells which limits the amount of fat that will “take”)

On average, 200–500 milliliters of fat are needed to obtain a one-cup increase in breast size. The range is based on chest size (ie. 32, 34, or 36). The larger one’s chest size, the more fat is required to produce an increase of one cup size. Therefore, patients must have sufficient amounts of quality fat that can be harvested and used for the procedure.

Fat graft survival can be increased by several different surgical techniques. The following harvesting and transfer procedures are typically used to maximize the percentage of fat cell survival.

• Harvesting of fat under low pressure rather than using high-pressure liposuction
• The harvested fat should be washed to remove the blood and other debris
• Excess fluid and debris are then separated from the fat 
• The fat should then be injected using multiple injections to evenly disperse the fat throughout the breast, allowing each group of fat cells the best chance to develop its own blood supply for survival (bonus injections will not survive).

When the surgeon uses these techniques, it has been found that at least 70- 80% of the fat cells will survive. Additionally, patients can improve the survival rate of grafted fat cells by increasing insulin secretion in the immediate postoperative period. This can be accomplished by eating a high carbohydrate diet for a few weeks following fat transfer. Also, avoiding the gym for 8 weeks and avoiding direct pressure on the breasts will help survival. NO ICE to the fat grafted breasts for 6 weeks! Patients should also NOT try to diet and lose weight after this procedure because the transferred fat will be the first to dissipate.

Breast augmentation surgery is one of the most common cosmetic procedures and can be performed using the body’s natural tissues with a fat transfer. While this procedure is not without risks, fat transfer breast augmentation in general has a better safety record and fewer complications when compared to augmentation procedures using implants. But fat transfer is NOT an equivalent option to implants. The results are NOT the same. Fat transfer will not achieve a firm round implanted look.

The minimally invasive nature of natural breast augmentation using harvested fat leads to a quicker recovery and less postoperative discomfort. Although there are two procedures during a fat transfer surgery, fat harvesting and donor fat cell injections, the recovery is typically easier. 

The Lipo harvesting component uses small incisions ( 1 cm) to harvest fat cells under low pressure, which is generally safer than high-pressure liposuction. Next, the injection of the fat cells is accomplished without an incision, which significantly improves healing rates and is associated with virtually no scarring. Therefore, providing the breasts with a more natural, fuller appearance.

The negatives associated with a fat transfer breast augmentation include:

• Limited increase in breast size. This limitation is patient-specific and may be restricted to a one- to two-cup size increase in many patients.
• Unpredictable fat cell survival. Board-certified plastic surgeons meticulously perform the harvesting and injecting of fat cells to enhance survival rates. However, some of the injected fat cells will be absorbed, reducing the enhancement and requiring repeat procedures to accomplish the desired results.
• Longevity concerns. Unlike breast implants, a fat transfer procedure can be significantly altered by pregnancy, aging, and weight loss, increasing the risk of sagging and reduced fullness over time. 
• Oil cysts and calcifications. Calcifications can develop in the breasts even without any fat transfer. Dr Pautler will have her patients get a mammogram prior to the fat transfer to document the presence or absence of calcifications. If calcifications occur from the fat transfer, which is not uncommon, usually no treatment needs to be done. Oil cysts can also occur, which may or may not be palpable. Large ones can be aspirated if needed. Both oil cysts and calcifications from fat transfer are benign conditions.
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It is possible to increase breast size by two cup sizes with a fat transfer procedure. However, this is typically NOT the case. To increase the breast by two cup sizes, there must be enough available fat to be used during the transfer procedure and the recipient breast envelope has to be stretchy. Fat is soft and will not do well in a tight breast. The amount of available fat needed for the procedure depends on the starting size of the bust and the compliance of the breast tissue envelope.

 A consultation with a board-certified plastic surgeon experienced in fat transfer procedures can help provide personalized recommendations regarding what can be accomplished with this surgery.

Technically, you are never too old for breast augmentation surgery if you are in good health. Many women in their senior years have breast reconstruction surgery with implants after a mastectomy or removal of breast due to breast cancer. Older ladies, in general, are just as good candidates for breast augmentation as younger ones.

According to the FDA, you must be over 22 to receive silicone-gel breast implants. Your body does not reach its full maturity until this age. With saline breast implants, you can be 18 to undergo breast augmentation surgery. You can be younger than 18 to receive saline breast implants but only with parental consent.

In most cases, you will be able to breast feed after breast augmentation surgery particularly when breast implants that are inserted beneath the pectoral muscle. With this breast augmentation approach there is no alteration to the internal architecture of the breast and the breast ducts remain attached to the nipple.

Not for the long term, however, a light compressive bra should be worn during any exercise or physical activity. During recovery, strenuous physical activity should be limited, do not lift heavy items and do not put your arms over your head as this can affect the healing process. If your implants are sub-muscular, avoid tricep dips, unassisted pull ups, heavy bench presses, or push ups for 8-10 weeks to avoid implant displacement.

There is no set time-limit or expiration dates on any breast implant. They could last up to 20 years or possibly more. However, you may need corrective breast augmentation surgery due to effects on the breast such as gravity, pregnancies or breastfeeding. It is very rare for an implant to spontaneously rupture. They can rupture however due to external factors such as being punctured in an accident or blunt force to the chest wall. There is more of a risk of rupture when the implant is in front of the muscle. You can tell fairly early if a saline breast implant is ruptured by the appearance. Whereas with a silicone breast implant, a leak is virtually undetectable to the eye and requires ultrasounds or MRI’s to detect.

It is preferred to place an implant behind the muscle. In this case, the surrounding breast tissue and scar tissue have a better chance to heal properly and hold the breast implant in place. It also has less impact on mammograms and breast feeding. In some instances, a breast implant can be placed in front of the muscle if the patient has enough breast tissue to support it. Dr. Pautler will discuss the pros and cons of placing a breast implant in front or behind the muscle in your particular situation at your initial breast augmentation consultation. For more information or to make an appointment for your initial breast augmentation consultation, contact Dr. Pautler’s plastic surgery practice near Pittsburgh.