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Fat transfer breast augmentations proving successful, but challenges remain

Article-Fat transfer breast augmentations proving successful, but challenges remain

Key iconKey Points

  • Improved techniques allow for high fat-survival rate, zero interference with mammograms
  • Ideal candidate for procedure would be seeking only moderate enlargement of less than one cup size
  • Future of breast augmentation with implants may be increased by the versatility of fat grafting, expert says

Todd K. Malan, M.D.
Innovative Cosmetic Surgery Center
Scottsdale, Ariz.

Dr. Malan
"This is truly an exciting time for fat transfer breast augmentation. What began as a controversial (and at one point banned) procedure in the mid 1980s has re-emerged today as a minimally invasive cosmetic surgery procedure.

"Many people don't realize that micro-deposition fat transfer (where fat is harvested via liposuction) came to the United States in the mid 1980s, at the same time traditional liposuction did. Unfortunately, the equipment used in those early days damaged fat tissue as it was harvested. We didn't understand that the fat cells needed to be injected in microdroplets to survive the transfer. Survival of the fat cells was very poor, and many industry professionals feared the resulting scar tissue and calcification would make it difficult for mammograms to accurately detect breast cancer. As a result, fat transfer to the breast was abandoned in the U.S. in 1987.

"Efforts were continued in Europe and Asia to improve upon the technology, and in 2007 Japanese doctors released a study on a new technique in fat transfer to the breast that met with very good success. These doctors had begun to utilize stem cell-enriched fat. The stem cells, found in abundance within the harvested fat, were isolated from a portion of the fat tissue, activated and re-concentrated with the remaining fat tissue and then injected. The stem cells then went to work creating new blood vessels that would supply oxygen to the grafted fat, ensuring long-term survival.

"A handful of doctors in the U.S. looked at the Japanese study, as well as techniques being used in Germany and Brazil, and developed a technique that employed the best aspects of these procedures. We discovered the key to successful fat transfer lies in removing the fat with minimal damage and injecting it into the breast in microdroplets. This new technique achieves both a high fat-survival rate and zero interference with mammograms.

"Are we there yet? As I see it, we are very close to perfection. While we're having phenomenal success with our current protocol for fat-transfer breast augmentation, we do have a few challenges to overcome.

"First, there is continued room for improvement with the procedure itself. We're now at a point where we see a consistent 80 to 90 percent fat-survival rate, as opposed to less than 50 percent three decades ago. We are continually striving to find better methods to remove fat without damaging it, and we have not yet determined the ideal location in the breast to inject the cell-enriched fat. Should it be injected in the superficial fat layer, beneath the gland or in the muscle? We are working to answer these questions.

"Second, a number of physicians are now offering stem cell-enriched fat-transfer procedures without truly understanding the techniques and equipment that ensure the best possible results. Only Cytori Therapeutics has created a tested, proven automated device to process and activate stem cells. Nothing else on the market has been tested or documented in a formal study.

"So, while great strides have been made in fat-transfer breast augmentation, the field as a whole risks a negative backlash unless physicians educate themselves on best practices."

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