Miami — A small clinical study of 25 patients has resulted in some viable reasons for revisiting breast augmentation using the patient's own fat.
According to Thomas Baker, M.D., director of Baker Plastic Surgery here, and co-author of the study, the research was undertaken to find out two things: Whether large quantities of fat injected around the breast would survive, and whether a device which creates negative pressure over the breast would increase the recipient space and circulation into the breast.
"We found that autologous fat can survive in large quantities if done with the proper technique," Dr. Baker tells Cosmetic Surgery Times. "In addition, use of a Brava device (a breast enhancement and shaping system) can increase the space, as well as circulation within the breast, boosting the number of blood vessels that can revasculate."Breast volume of all of the study participants was measured using MRI.
"It is our opinion that the MRI is a much better tool for diagnosing breast cancer and fat necrocity than ultrasound and mammography," Dr. Baker says.
Next, large quantities of fat were harvested using 10 cc syringes and 1 mm to 2 mm cannulas. Harvesting fat this way, rather than by liposuction, provides an atraumatic approach, according to Dr. Baker.
He serves as professor of plastic surgery at the University of Miami School of Medicine in a voluntary faculty position, is a clinical professor of plastic surgery at the University of Texas Medical Branch, and is an educational foundation professor for the International Society of Aesthetic Plastic Surgery.
Using gentle pressure, microdroplets of fat were injected using a peri-glandular process around and under the breast, rather than into the breast.
"It is our impression that micro-droplets survive better than larger grafts," Dr. Baker says. "We didn't want to create any possibility of fat necrosis being confused with cancer."
Not a single woman in the study group was disappointed, according to Dr. Baker.
The breasts look and feel normal. Unlike silicone or saline implants, which can ripple, have palpable edges or get hard, this procedure creates none of these.
Eighteen months after the procedure was performed, no complications, infections, hematoma or other problems were reported. Follow-up MRI studies performed after three and six months showed that 95 percent of the transplanted fat has survived. Five of the patients showed minute fat necrosis, a phenomenon that also is seen in patients who have had breast reduction using liposuction.
But will there be additional fat necrosis over time?
"I would think not," Dr. Baker says. "If it survives for six months, it will become like the area it came from. If a woman gains or loses weight, the fat will act like the fat cells in the rest of the body."
For many years, injecting fat in large quantities was frowned upon by plastic surgery societies because fat necrosis would interfere with breast cancer detection. But MRI changed that.
"A benefit of using MRI is that we can determine what is fat necrosis and what might actually be early cancer cells," Dr. Baker explains. "And physicians and radiologists from Harvard Medical School have confirmed that they can differentiate fat necrosis from early cancer cells. The downside is that it's expensive. But I think we're going to see the day when MRI is the procedure of choice."
Broad appeal lacking
Despite positive feedback from study group participants, Dr. Baker does not think the procedure will ever hold broad appeal for patients or surgeons.
"It's much too time-consuming and cumbersome," he says. "This is an option for women who absolutely refuse foreign objects."
Another drawback of the autologous fat breast augmentation procedure is that it requires two teams, harvesting fat for more than two hours, to add an average volume of 200 cc. The range is 90 cc to 300 cc.