megavolume fat transfer, second blog- how do we optimize where we graft to? (the face or breast)

Posted on April 20, 2014

shutterstock_105091349This is part two of my megavolume fat transfer talk.

Recipient site constraints.

We have more success grafting in small amounts (like we do in the face) or into really vascular spaces (like the muscular buttock).  But what about grafting a large volume into a tight space (like the breast) or a scarred, previously radiated or previously infected area? What about the skin that just won’t stretch?

Percentage Volume Change

Stating this in English, you can only increase the volume of what you are grafting into by so much.  If you try to over stuff the area, the skin will be too tight, and it will exert pressure on the stuff inside.  Pressure on the newly transferred fat is not good. It will cause the fat to melt, and it will cut off the blood supply to the new fat.  No blood flow = no graft survival.  With breast augmentation with implants, the implant is not a living thing.  You don’t need to worry about pressure against the implant.  Fat grafting uses living fat cells.  It is totally different.

What is the tissue like which you are grafting into?

I hope this helps with some understanding of why we do what we do.  I know my BRAVA patients wonder why they go through all the trouble.  In the future I hope we will be able to have more objective measurement of the tension and pressure.

Remember this is not all of the picture.  Please see my prior blog on fat survival, but there was a good study which found fat survival rates vary by individual.  They think the CD34 marker may correlate.

So, as with all things in life, the fat transfer success rate is multifactorial: your individual fat survival, the tissue you are grafting into, the pressure in the new space, among other factors.