By Frederick N. Lukash, MD, FACS, FAAP

Fat grafting is a hot trend in plastic surgery, in fact, you have probably heard about it in the media. This is a technique that takes fat from one place on the body and moves it to another. Fat grafting is a common procedure used in buttock augmentation, however, it can also be used for breast augmentation.

Recently there was a study published in the February issue of Plastic and Reconstructive Surgery that found that this technique can be safely used during breast reconstruction following a partial or total mastectomy. Research suggests that using women’s own fat cells to enhance breast reconstruction following cancer surgery doesn’t increase the risk they will experience a recurrence of their disease or develop a new cancer.

It’s not to say that fat grafting is a replacement for breast implants or breast reconstruction after cancer, but is an alternative that should be considered and is becoming more mainstream.

What are the benefits of fat grafting?

Fat grafting utilizes your own body tissue, potentially eliminating the need for implants. There is no one implant that is suitable for everyone, which is why we have round, contoured, smooth, and textured options. However, anyone that has unwanted fat on their body is a good candidate for fat grafting. In certain patients, they may not have enough fat to spare, but fat grafting can be used in conjunction with smaller implants for a more natural look, as the fat can be used for shaping as well as volume.

Where is the fat taken from?

The fat can be harvested with special liposuction techniques from multiple donor sites. This includes the abdomen, love handles, back, thighs, or hips. This allows for body sculpting, which is an added bonus.

How long does the process take?

BarbarellaA wearable device called BRAVA expands the breast tissue and helps to increase circulation, which enhances the survival of fat. BRAVA stands for breast augmentation with vacuum assist. The BRAVA system is a dome-like cup worn over each breast, much like a bra, for 4 hours a day for 3 weeks prior to surgery. Think “Barbarella.”

We do not inject fat into the existing breast tissue, but rather creating an envelope that the breast tissue sits in. With fat grafting and use of the BRAVA, there may be multiple stages involved, but each procedure is outpatient, and there are virtually no scars. For breast enhancement using fat grafting, a candidate may need 1-2 outpatient procedures depending on desirability of size.

Who is a good candidate?

Fat transfer can address various concerns in different types of women and at different ages. You can go up a full cup size after one treatment. It’s a procedure to consider to regain lost breast volume post-pregnancy. It is also an option for women who have had breast implants who may be experiencing problems, such as asymmetry or capsular contracture. Or, for women who want their implants removed, but still want to maintain the volume.

This procedure can also be beneficial to women with congenital issues such as tuberous breasts. The fat transfer technique is often used in young women as it is a less invasive treatment and allows for more control of shape than an implant.

In reconstruction patients, specifically after mastectomy, fat transfer is an option to help to reconstruct a breast. Yes, you can transfer tissue with a tram flap or diep flap, but those are big surgeries, with big donor sites, long recoveries, expanded risks, and increased time under anesthesia. It is rarely one and done.

For this type of reconstruction, a candidate may need 3-4 outpatient procedures to get all the fat to properly transfer. From start to finish, it can take anywhere from 6-9 months depending on the desired volume, with 3 months between fat transfer procedures.

There’s no substitute for using your own tissues. As plastic surgeons, we want to do what we can to make patients the most comfortable in their own skin. With fat transfer, we are robbing Peter to pay Paul, and in this case, Paul needs it, and Peter can afford it.

Click here to view patient testimonials from fat grafting to the breast procedures.

Fat Transfer BNA

42 year old female with loss of breast volume from a bilateral breast reduction 20 years ago and a right sided lumpectomy followed by radiation 10 years ago a bilateral Combination left her with a significant indentation and scarring on side of lumpectomy and a breast size too small for her frame. Treatment was with BRAVA and fat grafting to both beasts. The defect is filled in and the overall breast volume increased. She is considering a second grafting to further increase her breast size. The fat is rejuvinative to her radiated tissues whereas implants would not be advisable.

Fat Transfer Case 2

17 year old female with congenital asymmetry to breasts. By reducing the larger breast and fat grafting the smaller breast twice after BRAVA symmetry and appropriate size was created.

42 year old female who presented initially with a deformity from having a breast implant rupture and require removal. Her other breast remained with an implant that was not flattering to her figure. She underwent 3 BRAVA and fat grafting procedures followed by insertion of a small implant on the right and a replacement with an implant on the left more harmonious to her frame.

42 year old female who presented initially with a deformity from having a breast implant rupture and require removal. Her other breast remained with an implant that was not flattering to her figure. She underwent 3 BRAVA and fat grafting procedures followed by insertion of a small implant on the right and a replacement with an implant on the left more harmonious to her frame.