- Outcomes of fat grafting in the breast depend on technique, surgeon expertise
- The question of how much fat survives after breast lipoaugmentation has been a controversial issue
- Fat grafting affords the surgeon greater control in shaping the breast
Surgeons who perform fat grafting of the breast acknowledge a need for further research to answer a number of questions about the procedure. But based on available evidence and their personal experience, they consider lipoaugmentation a valuable option for select women seeking cosmetic breast enhancement and for those with various reconstruction needs.
"Autologous fat injection with or without stem cell enhancement appears to be a very worthwhile alternative for addressing a variety of plastic and cosmetic breast issues, and one of its benefits is that it avoids the potential risks associated with large tissue grafts, flaps and implants," says Maurice Sherman, M.D., who discussed lipoaugmentation of the breast at The Art of Cosmetic Breast Surgery, a workshop preceding the annual scientific meeting of the American Academy of Cosmetic Surgery in January in Phoenix.
A patient before (left) and five months after breast lipoaugmentation using approximately 300 cc of autologous fat injected into each breast. (Photos credit: Sean Rice, M.D.)
Sean Rice, M.D., spoke about harvesting techniques and primary augmentation with fat at the 11th annual Toronto Breast Surgery Symposium in Toronto. He emphasizes the need for patient education. "As with any procedure, patients choosing breast lipoaugmentation need to be well-educated, so that they have appropriate expectations and are aware of potential risks. In addition, as highlighted by the 2009 report of the American Society of Plastic Surgeons (ASPS) Fat Graft Task Force, patients and surgeons must realize that outcomes of fat grafting in the breast are very dependent on technique and surgeon expertise," Dr. Rice says. "This means women interested in breast lipoaugmentation should be careful in selecting a surgeon, while surgeons who want to perform these procedures should be prepared to face a learning curve."
CANCER DETECTION In 1987, concerns that postlipoaugmentation scarring and calcifications could interfere with detection of early breast carcinoma led the American Society of Plastic and Reconstructive Surgeons Ad-Hoc Committee on New Procedures to issue a statement deploring the use of autologous fat injection in the breast, Dr. Sherman says.
"This condemnation not only limited use of the procedure worldwide, but also research and discussion of the topic," he says. "Fortunately, reports began to surface during the 1990s on the success of autologous fat grafting in breast reconstruction that led the society to re-evaluate its position."
In 1997, the ASPS recommended that lipoaugmentation of the breast undergo further review as a potentially worthwhile treatment modality. In 2009, based on a comprehensive review of the literature, the ASPS Fat Graft Task Force concluded there was no evidence strongly suggesting that fat grafting to the breast could interfere with breast cancer detection. The group called for more studies to confirm what they considered still preliminary findings, but they also concluded that fat grafting may be considered for breast augmentation, as well as correction of defects associated with medical conditions and previous breast surgeries.
Regarding the cancer-detection issue, Dr. Sherman says the macrocalcifications that can occur with any type of trauma to the breast are easily differentiated from the microcalcification pattern of early cancerous changes of the breast. Dr. Rice says radiologists have experienced no difficulties identifying breast cancer in women with a history of mammaplasty, which results in much more significant scarring and mammographic changes than fat injection. He says, however, he encourages his patients to make sure the radiologist who reads their cancer-screening studies has solid competency in interpreting the images. Women are instructed to obtain a mammogram or MRI prior to a lipoaugmentation procedure and to have regular follow-up studies, beginning about one year after the procedure.