Fat Transfer Breast Augmentation (Natural Breast Enlargement)

The History of Breast Augmentation

Breast augmentations are one the most common female cosmetic procedures performed. In 2010 the USA performed 13 million cosmetic procedures (ASPS). Of these, 300'000 were breast augmentations. The majority of these were Silicone based implants followed by Saline filled implants.

The first breast implant procedure was performed 50 years ago. The patient, Timmie Jean Lindsey, now 80 years, was very please with the result and the implants are still "alive".

Over the last 30 years the industry has evolved immensely.  Numerous implant manufacturers have come and gone and surgical techniques have been improved on and modified.

The first implants were silicone based and subsequently other types have come onto the market including soya based and saline filled implants.

Currently the most common type of implant used is Silicone.  The choice of implant used depends on the desired shape and size the patient requires and also on surgeon preference.

Other augmentation procedures that exist are musculo-cutaneous flaps (muscle and skin grafts; DIEP, TRAM, Lattissimus dorsi) that are taken from one area and transposed to another.  These are mainly used for reconstruction purposes for cancer survivors.  Occasionally surgeons also use tissue expanders to create an envelope and then insert an implant.

With the cosmetic industry being flooded with dermal fillers the aesthetic company Q-Med launched a product called Macrolane (Hyaluronic Acid filler) which was used as a body contouring filler.  It is a degradable product which is injected into a pocket underneath the breast tissue and is used to enhance the size and shape of the breast.  It is also used as filler for buttocks, calves and male pecs.  The product lasts approximately 9-12 months and then the procedure can be repeated.  At present the license for breast remodelling has been revoked until a consensus can be agreed upon for screening modalities in women with the filler.  The product is still used for general body contouring.  There are no safety issues regarding the product.

Fat Transfer Breast Augmentation (autologous fat transfer)

With the current PIP scandal many women are looking for other alternatives to formal surgery and implant procedures.  Autologous fat transfer or fat graft is fast becoming a popular choice.  The first breast fat graft was performed by an american surgeon and described in the American Journal Plastic and Reconstructive Surgery in 1987.  There was a big uproar by his fellow surgeons as there was not enough scientific evidence to support the procedure, its consequences and risks.

However, in 2007 Sydney Colemen, a major proponent of fat graft procedures, suggested that it was "time to end the discrimination created by the 1987 position paper" and " judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure."

The Procedure

The surgeon will usually do a psychological assessment to ascertain the suitability of the patient and gain insight into the patients' expectations.  The patient then also needs to be assessed for suitability in terms of fat content and breast suitability.  Pre-operative imaging is important to assess symmetry, volume, shape and also for comparison postoperatively.  

Fat is harvested via a liposuction technique and filtered to get rid of any unwanted material such as local anaesthetic, blood, connective tissue etc.  Many women see this as a 2 in 1 procedure as they have fat removed from areas that they don't like and at the same time get an augmentation.  Nowadays the procedure is performed under local anaesthetic and conscious sedation which removes the risks of a general anaesthetic.

The pure fat is then injected into the breast to enhance the shape and size. The limiting factors are really is there enough tissue to chance the breast significantly and are the breasts suitable for the procedure.

Risks
Although the procedure is done as a day case it is still a surgical procedure and thus needs to be treated as such. Risks such as infection, abscess formation, bleeding, asymmetry, fat necrosis, fat cysts are important to bear in mind. The fat retention volume is somewhat unpredictable, but presently rates of 50-70% are achieved. This will vary from patient to patient and there is the risk that almost all the fat will be lost.

One of the most important possible side effects is the occurrence of calcifications. When fat does not survive it may form small spicules of calcium that are visible on mammograms. Calcifications are sometimes associated with suspicious lesions on mammograms and often require further investigations and tests. When supplemental imaging modalities are considered such as digital mammograms or MRI scans calcifications from fat necrosis can be distinguished from the malignant signs of irregularly shaped, high-opacity micro calcifications. It is to be remembered that not all fat graft procedures will result in calcifications.
Of the thousands of fat grafts performed to date there has not yet been a case reported of a missed cancer diagnosis on mammogram due to a fat graft procedure.

Numerous scientific papers have since been published on the topic (Fulton, 2003; Spear, 2005; Missina, 2007; Carvajal, 2008; Illouz, 2009; Hiko, 2009; Delay, 2009; Da Li, 2009; Veber, 2011; Cong Feng, 2011; Claro, 2012) and the conferences are full of presentations on techniques, experiences, outcomes and imaging modalities for cancer screening purposes. 

Recently an american author has undergone a cell enriched fat graft to the breast after having a large lump removed (http://tinyurl.com/d6jjmn8).
The largest followup series of fat grafts has been reported by Illouz and Delay looking at over 1000 patients over a 10 year period respectively.  Although there has been heated debate about whether fat graft to the breast will interfere with the interpretation of mammograms the ASPS position paper indicated "no evidence that fat injections interfere with breast cancer detection and that results of fat transfers remain highly dependent on a surgeon’s technique and expertise".

 Fat Transfer Breast Augmentation procedure

Dr Wolf performs 3D imaging on all patients to compare before and after shapes and sizes.

As an alternative to implants the autologous fat graft breast augmentation will certainly become a lot more popular option.  The benefits include day case procedure, conscious sedation, natural look, feel and shape.

The procedure is still a surgical procedure and comes with its inherent risks.  Patients need to be properly assessed, evaluated and consulted regarding the procedure risks and possible side effects.
Here is a post of a very pleased patient.........

Come see our website www.DrWolf.com

Come see our website www.DrWolf.com 

PLEASE SEE MY LATER POST ON AN UPDATE ON THIS TOPIC  click here

VASER Breast reduction - non surgical

The female breast reduction procedure is generally a surgical procedure to reduce the weight and size of the breasts.  During the surgical version of the procedure fat, gland and skin are removed to resize the breasts and in most cases the nipple needs to be repositioned.

Breast size varies in women and often there is an asymmetry between the left and the right side.   A variety of factors determine the size and shape - genes, hormones, body frame, weight and lifestyle.
In later life the breasts often lose volume and may become droopy, especially in some that have breast fed and have had children.

Breast reduction can assist in lifting the breasts and changing the size, weight and shape.

Physical problems may also include:

• backache 
• neck pain
• skin irritation
• poor posture
• excessive sweating, rashes and skin
• infections under the breasts
• weals or grooves on the shoulders from bra straps
• an inability to exercise or take part in sports

Common psychological problem also include:

unwanted attention or harassment

self-consciousness

depression

Traditional breast reduction involves a general anaesthetic and fairly extensive scars that take on an "anchor shape".  Many women find this option unattractive due to the risk factors.


An alternative to this is VASER Breast Reduction. 
The procedure is performed under sedation and local anaesthetic.  The access points are very small (5-6mm) and heal to leave almost no scar.  The postoperative care includes MLD sessions which remove unwanted fluid and swelling.  The breasts will be relatively firm and swollen for about 1-3 months, although this various between individuals.  MLD sessions help alleviate the swelling.
As the VASER helps contract the skin it also creates a bit of a lift of the breast.


The main benefits of VASER breast reduction are:

• volume reduction
• weight reduction the breasts
• reduce backache and neck pain
• marginal lift
• local anaesthetic
• minimal scarring
• day case procedure

Dr Wolf recommends a mammogram before and about 6-12 months after the procedure.

VASER - MLDUK conference

I was kindly invited to give a talk at the MLD conference in May to share my experience of VASER and what recommendations I had for MLD therapists with regards to post-op treatment.  The talk was fairly general with an overview describing the treatment and its indications to give the MLD fraternity an idea of what is achievable.
I was very surprised at how many therapists had come across VASER patients and had actually treated them; quite a number of them being my patients.  I was very please to hear that I was one of the most active MLD supporters for VASER patients.
Traditional liposuction surgeons tend not to refer patients for MLD - not sure why?  They are possibly unaware of the benefits.

The benefit that patients receive from having these treatments post-op is immense, not just in terms of reducing swelling and bruising, but also minimising subsequent risk of irregularities and lumps and bumps. Most patients will report softening of the tissue immediately post MLD.  The treatment is also very relaxing and most therapists will show the patients self-help techniques they can perform at home on a daily basis.

There is significant scientific research to support the benefits of MLD in the post-op period.
As patients vary significantly in their healing phase the number of sessions required varies from individual to individual.  Generally I would suggest starting with 3-5 in the first 2 weeks and then re-assessing the situation.  Most practitioners will have one post-op review in that time and can then recommend further sessions if required.
For Hi Def patients the treatment regime is more intense and rigorous for the first 2 weeks (almost daily MLD sessions).

All in all it was a very interesting meeting with copious networking opportunities.