fat grafting for augmentation or reconstruction

• breast augmentation
• breast lift (mastopexy)
• breast reduction
• gynecomastia
• revision breast surgery
• fat grafting for augmentation or reconstruction
• breast reconstruction (cancer)
• breast questionnaire

fat grafting

This is a new fronteir of breast augmentation.  I went to my first meeting to learn how to do fat grafting two years ago.  Fat grafting is not new.  We have been doing it for years.  As we have studied it we have refined our techniques and looked at ways to maximize fat “take”- that is fat living where we move it to.  I then spent time in 2011 with Dr. Khouri in Miami to learn from him, as he is one of the surgeons who has the most experience and has been thoughtful in his study of fat grafting and how to improve the results. 

how do you do fat grafting?

Fat grafting involves doing liposuction of your body to harvest the fat we need to transfer.  The fat is removed by small cannulas.  It is then centrifuged to help separate the liquid from the fat.  The fat is then injected using small special cannulas into the breast.  I use a pattern which looks like a clock.  There are no big incisions for the fat injections- it is done through small openings I make with a needle.  The fat is placed in small droplets, called micro fat grafting.  I fan out the level and where the fat is placed, to create a kind of matrix. 

Surgery takes a little longer than traditional breast augmentation due to the harvesting of the fat.  Pain tends to be less, as most breast augmentations go under the muscle and fat grafting is on top of the muscle. 

This is a complex topic and still a “new” procedure for plastic surgeons.  Please read my many blogs on the topic.  I was impressed by what I saw in Miami.  There are issues with breast implants.  They can turn hard, migrate, thin the overlying tissue, biofilm or infection, and need to be replaced.  Many of my patients want small augmentations and would like to avoid implants.  It is with all I have learned and seen, the impressive results and thoughtfulness of those doctors I studied with, and the understanding my patients and their desires that I have started to offer this procedure to my bay area patients.  I am pleased with the results I am seeing. 

I also use fat grafting as an adjunct to my breast cancer implant expander patients, to help “thicken” the tissue over the implant and give a better contour.  There are many amazing qualities to fat.  One I saw when in Miami is the improvement in the radiated skin.  Patients talked about how their nerve sensation to their breast flaps improved after the fat grafting. (One patient had her mastectomies years before.  Had no feeling in her skin.  The feeling returned after fat grafting.)  Fat can be used alone for the reconstruction.  This involves serial surgeries which are outpatient with quick recoveries.  The number of surgeries varies with volume needed and if you have had radiation or not. 

Fat grafting can have issues.  Again, I would reference my blogs.  Fat grafting to the breast for breast enlargement is not for everyone.  There are limitations.  Of note I would counsel those who are looking into fat grafting to find someone thoughtful and trained in fat grafting.  Using the BRAVA system, knowing the techniques on how to maximize fat survival, and good counseling are important for you to figure out if you are a good candidate, and if you are, for you to get a good result.