Autologous fat transfer

If you have small breasts and you are considering a breast augmentation, and you have enough fat that you are considering liposuction then it may be possible to use your own fat for breast augmentation. Autologous fat breast augmentation (AFBA), however, is a slightly contentious topic for some surgeons and a hot topic for others. Not every patient seeking breast augmentation is suitable for a breast augmentation with their own fat. Most patients who want a breast augmentation do not have enough fat for a satisfactory enlargement and even in those who do, there are other considerations.

Strong family history of breast cancer or BACa 1 and 2 positive: A strong family history - breast cancer in your mother or sister - does not necessarily exclude you from the procedure, but there have been concerns that it would be unwise to perform an AFBA in this setting. Similarly if you are BACa positive (the gene for breast cancer), you have a greater risk of getting breast cancer. In these situations, because of your higher risk and because of the potential difficulties in identifying the changes which may occur with breast cancer vs. the changes which may occur with fat grafting as seen on mammogram, it is considered unwise to do AFBA.

So, you have no significant family history, you have been tested for the gene and you are negative, and you have enough fat for an AFBA, what are the other concerns? The main concern is size and shape. Although about 200-250 ml of fat can be put in the breast in one go, because this is transferred as a graft (a non-vascularised tissue transfer), the fat needs to pick up a blood supply in its new, recipient site. Some does (and lives), some doesn't (and dies and gets resorbed). There is therefore inevitably some incomplete fat take with some volume loss after surgery. The average size implant that I put in is around 300 ml; more than you will get with AFBA.

In terms of shape, a breast implant gives you a full rounded shape to the breast, an AFBA gives you a more natural, softer breast, but with a less rounded shape.

With the unpredictability of the graft take and the inevitable loss of some of the graft volume, it is fairly likely that you will require a second and even a third procedure. It is frequently difficult to achieve the volume that most patients want at one sitting, and at the second op it may be difficult to find sufficient fat for grafting.

Controversy exists about whether one needs to do pre-operative external tissue expansion prior to surgery to enlarge the breast skin envelope to accommodate the fat and to improve the vascularity so as to enhance fat take. External tissue expansion is usually achieved by wearing the Brava device. The Brava device needs to be worn for 2-3 months for 8-10 hours a day. It is an external plastic suction device that fits over the breast. Suction is applied to draw the breast into the large plastic breast container. The Brava can be worn in the bra, but it is cumbersome and expensive. Currently (September 2010) there is no evidence to support the use of such a device and there are no randomised trials looking at AFBA with and without Brava. This situation may change, but currently I do not use the Brava (although there are plenty of surgeons who do).

Finally there is the issue of cost. Since you will require a fairly extensive liposuction to harvest the fat into multiple syringes (20-30 per side) and then re-injection of this fat into the breast, the costs of surgery are more than a conventional breast augmentation.

I do the surgery like I do my other surgery. It is performed as a day case procedure (in and out the same day) in my own, private facility. I use women anaesthetists who will put you under a light sedation. This will be supplemented with local anaesthesia and a spinal injection for the lipo. You will be asleep, pain-free and unaware at the time of surgery and you will have a quick recovery.

We will lie you on your tummy first to harvest fat from the areas at the back (love handles, buttocks, thighs, etc). We will then turn you over and harvest fat from the front (tummy, thighs, etc). The harvested fat may be treated with centrifuge (see fat transfers) prior to injection into the breasts. Usually I inject the fat through2 or 3 tiny puncture wounds in the breast crease and in the areola. The fat is placed deep under the breast gland and into the fat layer under the skin.

Post-operative care is as for liposuction and breast augmentation.

Potential complications are as for liposuction and breast augmentation (although without the implant-related complications). In addition there are the potential complications of fat grafting: irregularity, lumpiness, under-correction (over-correction is not really a problem in this area!)

Article written: 27 September 2010