Breast Augmentation Using Your Own Fat
For the last 50 years, plastic surgeons have been performing breast augmentation by inserting silicone implants behind the breasts. The main advantage of this operation was that the woman could, within reason, choose the size of the implants that she wanted. Although initially women chose implants of modest volumes (150 – 200 cc) this gradually increased so that women now commonly request sizes of 300 cc, 400 cc and more! This has led to problems.
Many women with breast implants have breasts which look artificial due to excessive fullness in the upper part of the chest. Sometimes the heavy implants sag on the chest wall which makes the nipples look too high. Some women have breasts which are unequal with one breast sitting higher than the other. The body reacts to the artificial implants by making a wall of scar tissue and many women end up with breasts which are hard and which look spherical due to the thick capsule of scar tissue which has formed around the implant. Recently surgeons have discovered that, with certain implants with a textured surface, a type of cancer known as ALCL (Anaplastic Large Cell Lymphoma) can form inside this capsule. And, of course, implants are not lifetime devices. Leakage can occur at any time, although the risk increases the longer the implants have been in place. All these problems mean that it is not unusual to hear of a 25% re-operation rate in the first two years after breast implants have been inserted.
All patients are advised that their implants “are not lifetime devices” and will definitely need to be removed and/or replaced at some future date (some surgeons advise every 10 years). This means that you have a 100% likelihood that revision surgery will be required! Surely there must be a better way to do breast augmentation?
Yes, we have performed hundreds of cases! Plastic surgeons have been transferring fat into the face and other parts of the body for over 20 years.
The amount of fat transferred has been relatively low (usually 10-20 mls) but the fat survived well and provided natural enhancement of the cheeks and lips without any ill effects. For the breasts, however, volumes of at least 100 mls are required and plastic surgeons were concerned whether such a large volume of fat could survive in the breast. Another concern was that fatty lumps could be created and that these lumps may be mistaken for breast cancer.
About 5 years ago, radiologists advised that they were able to distinguish between a breast lump due to fat and a breast lump due to breast cancer. With this reassurance, plastic surgeons in Europe, the USA and Australia began to develop techniques where larger volumes of fat could be harvested from the body, prepared by washing and filtration and then grafted into the breasts.
At Fat Transfer Australia, we use a Microaire Power Assisted Liposuction device to harvest fat efficiently (usually from the hips, thighs and abdomen) by tumescent aspiration. Following multiple cycles of washing and filtration, the fat is purified and prepared for grafting into the breast.
If 500 ml of fat is harvested, usually about 250 ml remains after the purification process and this allows us to graft 125 cc into each breast. Each cup size is about 125ml. If more fat can be harvested, then of course a larger increase in breast volume can be obtained. During the fat grafting process, the fat is distributed evenly throughout the breast tissue so that lumpiness is avoided. The fat is grafted into multiple tunnels to give the fat cells the maximum chance of survival. Usually, fat is preferentially grafted to enhance the cleavage and the upper pole of the breast but without causing excessive upper pole fullness. Once the fat has developed its own blood supply it has the capacity to grow and thereby further enlarge the breast.
Unlike with breast implants, where you can choose the volume you want, with fat transfer the result depends on how much fat is available and how the fat grows once grafted into your breasts. Even in very thin women, we are usually able to graft at least 125 cc into each breast. This is an increase in 1 cup size. For women with more fat available, then we have grafted as much as 400 cc into each breast and in these cases we have achieved an increase of 2 or more cup sizes.
Donor sites for the fat are the hips, thighs, inner knees and abdomen. If an excess of fat is available in these areas, then an added benefit of the procedure is that your body will be rebalanced and your body contour will be improved because of the removal of the excess fat. Many women find that they go down a size in their jeans following liposuction of the hips and thighs. Even if you have no obvious areas of excess fat, we know where to find enough invisible fat for the procedure.
There is virtually no scarring produced on the breasts as the fat is transferred by a small cannula with a diameter of only 4 mm. On the donor sites, only a few discreet scars (about 1 cm) are produced in order to facilitate harvesting the fat. These scars fade after 6-12 months.
Following the surgery, you can expect your breasts to be swollen for about 2 weeks. The donor areas (hips, thighs, etc.) are a little bruised and swollen and these areas also require about 2 weeks to settle. We recommend wearing a compression garment over the hips and thighs for 4-6 weeks to speed up the healing. You will be required to wear a supportive bra and to go on a scientifically developed programme for 1 month in order to encourage survival and growth of the fat cells which have been grafted into your breasts.
Yes, the fat cells that survive in your breasts will survive permanently, but of course your breasts may vary in size in the future due both to hormonal changes and weight changes.
Yes, breastfeeding is possible after this operation.
The breasts are not usually painful after the procedure, however the donor sites (thighs, abdomen etc.) are usually a little sore. You will be prescribed pain relieving medication.
Nipple sensation is not altered by this procedure. Because the breasts have been stretched, there may be a little tingling in the nipples for a few weeks after the surgery.
There has never been a case of breast cancer described due to fat transfer to the breasts. If you do develop a lump in the breasts following a fat transfer, then this must be investigated in the normal way. A mammogram or ultrasound will be able to distinguish between a lump due to breast cancer and a lump due to fatty tissue.
The grafted fat may occasionally form microcysts in the breast but this does not affect the detection or diagnosis of breast cancer. Artificial breast implants, on the other hand, do make detection of breast cancer more difficult.
No major complications are anticipated. In fact this operation is much safer than breast augmentation using artificial implants.
It is possible for the breast to feel a little lumpy after surgery and occasionally a breast lump will persist. The donor areas from where the fat has been harvested may show some contour irregularities which also occasionally are persistent.
As this is an aesthetic procedure, you may not be happy with the size of shape or your breasts after the procedure.
We prefer to perform this operation under a general anaesthetic so that you have maximum safety and comfort during the procedure. Our anaesthetists are highly qualified and experienced and are there to ensure your safety and rapid recovery.
The operation is more complex than the insertion of artificial implants because of the fat harvesting and purification processes involved but our specialised teams usually take less than 2 hours.
Yes, many women have fat grafted into their breasts to enhance volume as part of a breast lift procedure. This is a far safer method than inserting artificial implants (in fact many surgeons advise against using implants with a breast lift).
Yes, many women have fat grafted into their breasts to replace the volume lost when their artificial breast implants are removed. All report that their breasts are far softer and have a much more natural appearance.
Yes, many women having a tummy tuck have some of the fat that is removed grafted into their breasts to provide extra volume and a slight lift.
Yes, fat transfer will improve the cleavage and reduce rippling in women with breast implants.
The operation is usually done as a Day Case. You should be able to go home a few hours after the surgery, provided you have a responsible adult who will remain with you during your first night.
You will be seen the next day when your dressings will be checked. No drain tubes are required. You will be fitted with a supportive bra and you will also be required to wear a supportive compression garment on the areas from where the fat has been removed. You will be placed on a scientifically developed programme for 1 month in order to encourage survival and growth of the fat cells which have been grafted into your breasts.
Although we usually advise 2 weeks off work, you may be able to return to work sooner if your work is sedentary in nature.
You may feel a little stiff in the operative sites for a few days but most women are able to start driving a car after 2 or 3 days, at which stage you could start doing some light housework. You should refrain from vigorous activities (such as going to the gym) for about 6 weeks.
A sports bra is worn continuously for a month or so after the procedure to provide support to the healing breasts. A compression garment is worn over the donor areas for 6 weeks.
Even after having large implants inserted, some women wish that their breasts were even larger! Of course you can always have more fat grafted and we have done this for a few women with excellent results. However it does incur extra costs. You could even choose to have an implant inserted, although this would be a rare choice. Usually we would recommend staying on our scientifically developed programme a little longer to enable your breast fat to grow even more.
If, for example, you are an A cup and would like to be a D cup, then breast implants are currently your only option. In these cases, we still place a priority on your safety and so would recommend a smooth walled, saline filled implant placed behind the muscle. When performed by an appropriately experienced surgeon, this produces the softest and most natural result available with implants, with the least risk. For more information on our "SAFEST" technique for breast augmentation click here.
The surgeon may be inexperienced with the technique and may be excluded from performing it by his/her medical insurance organisation. He / she may feel that silicone breast implants provide a more predictable result in his/her hands. This is probably correct!