16 April 2014
16 April 2014,

Fat transfer is a process in which liposuction is performed in one area of the body and then that fat is transferred to any area of the body for augmentation.  It is a minimally invasive approach that will decrease areas of unwanted and stubborn fatty deposits by liposuction (hips and belly) and then move that fat safely up to the breasts.
I would not recommend fat grafting for breast augmentation unless you fully understand the risks and trade-offs, including unreliability of volume, possible asymmetry, risk of cyst formation, proper preparation and possibility of further surgery.

However, there are concerns regarding the breast that don’t really exist anywhere else in the body- most importantly the fact that cancer of the breast is not uncommon and we don’t yet know how fat transfer to the breast will eventually affect a breast that is destined to get breast cancer.  Will the risk of breast cancer change?  Will the ability to detect breast cancer change?  These are two of the critical questions that don’t yet have answers.  There is enough concern about these issues that I will not yet perform this procedure in my practice.
Most importantly fat will often calcify in the breast. Some types of calcifications on mammograms are cancer until proven otherwise. In the past women have received biopsies or worse procedures that they did not need to have. Up until recently the plastic surgery societies, (ASPS and ASAPS), did not want their membership to do these procedures. They still don’t, but they do state that there are some controlled studies that are ongoing. We will see the data as it comes back.
Fat injection is probably safe for breast augmentation, but there are theoretical risks for interfering with mammography and breast cancer detection in general, which is important since breast cancer is common. Some scientists have also expressed concerns that the fat cells could potentially increase cancer rates. Another consideration is that survival of the transferred fat is unpredictable, so fat injection may have to be repeated. Perhaps most importantly, patients should consider that breast enlargement with fat transfer produces a different ‘look,’ or appearance, than implants. Implants will tend to give a larger, fuller, higher breast. Fat injection will generally produce less fullness and a far more subtle enlargement.

Fat Transfer to Breasts

For years, the American Society of Plastic Surgeons had cautioned its members against performing breast augmentation with fat injections because of fears that the injected fat could interfere with mammograms, inhibit future breast cancer detection, and possibly stimulate breast cancer development.

Pros & Cons  

Pros of Breast Augmentation with Fat Injection:
1.  No need for breast implant
2.  Simultaneous liposuction of fat from an area of excess body fat

Cons of Breast Augmentation with Fat Injection:

1.  Can achieve only about 1/2 to 1 cup increase in breast volume. This is because usually in women requiring breast augmentation, they do not have enough excess volumes of fat elsewhere to give the desired increase in size. Any greater cup size increase would require huge reserves of fat volume for injection, and usually there is only enough to make a subtle difference.
2.  Approximately 60-70% of injected fat will not survive, making the need to harvest more for injection in the first place. If excess fat elsewhere is limited, this would not give much of a visible result.
3.  May require more than one operation to achieve desired size.
4.  Does not change the shape of the breast, nipple position, or sagging
5. The effect is not predictably retained over the next few years. There is some evidence to show that a great proportion of the injected fat is not retained after about 2.5 to 3 years, depending on where it is injected.
6. May lead to hard lumps in the breast that are difficult to distinguish from a breast cancer, necessitating numerous imaging, biopsies, and maybe unnecessary diagnostic or therapeutic procedures.
7. May make mammograms harder to read, with more calcifications seen in breasts that have had this performed.

Simply, Women who seek the look of a breast implant with fat transfer will not achieve it.  Breast implants and fat transfer do not give the same outcomes, as these are two very different treatments for patients who have different desires.

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