Fat Transfer to the breast – Facts, Benefits and Risks

Fat Grafting, also called Fat Transfer (FT), is the surgical process by which adipose tissues are removed from one part of the body called “donor sites’ ‘ to another part – by liposuction harvest and liquid fat injection. The surgical goal is to improve or augment the area where the fat is injected. Fat grafting has wide applicability, including both aesthetic and reconstructive procedures. 

Why is Fat Grafting controversial

Over the years Fat Grafting has been controversial, inviting extensive research to improve adipose tissue transfer technique, and to better understand the related benefits and complications. In addition, its potential interference with breast cancer screening was raised. As of today, many formalized clinical studies have evidenced the safety of fat grafting, allowing the procedure to gain widespread popularity thus opening possibilities for future applications. There is still a tremendous need for proper education when it comes to fat transfer, in particular addressing women’s concerns, but also addressing misinformation. 

This article examines the facts, risks and benefits of natural breast augmentation with fat cells transfer following Breast Reconstruction and or Explant surgery. 

Applications of Breast Fat Transfer (FT)

  • Fat transfer can be used during post-mastectomy reconstruction of the breast and while treating other conditions that occur after mastectomy, such as reversing damage caused by therapeutic radiation and breast implant removal.
  • To reshape breasts altered by lumpectomy and radiation.
  • To create primary breast augmentation without implants.
  • To add upper pole and cleavage fullness during Mastopexy (breast lift) after weight loss, pregnancy or aging, without implants.
  • To re-create fullness after en bloc explant surgery. This procedure is often done with breast lift surgery to improve upon sagging breasts and create more upper pole fullness, cleavage and symmetry of the breasts. 
  • A secondary benefit is the reshaping of the body using liposuction in the donor sites to reshape the body according to the patient’s needs and goals. 

ASPS position on Breast Fat Transfer

In 2009 the ASPS, American Society of Plastic Surgery stated that there was no association between fat grafting and higher rates of malignancy and that the risk of interference with breast cancer detection was nonsignificant, yet demanding for more clinical investigation.  This had popularized the concept that problems were more likely to stem from the surgeon’s skills and experience rather than from the procedure itself.

Today this procedure is regularly integrated in plastic surgery. Randall Feingold, MD who routinely practices fat grafting during breast reconstruction surgery and during breast implant removal, (explant surgery), explains that the success of fat transfer depends on incremental stages of layered fat grafting in addition to the plastic surgeon’s expertise and skills. Many of the original complications associated with fat grafting, such as unpredictable reabsorption and oil cyst formation, were addressed with the advancement of standardized adipose extraction, purification, and injection methods. 

Nowadays, reports of poor aesthetic results stemming from graft volume loss are relatively uncommon, and experienced surgeons can decrease the risk of such complications with intraoperative protocols. 

Fat transfer technique

The procedure involves removing fat cells from the donor site with a special technique that preserves the living fat cells. The fat may be cleaned, processed and purified prior to injection. Stem cells within adipose tissue have rejuvenating properties which in turn can help the breast heal after breast reconstruction or en bloc explant and breast lift surgery.

To transfer the fat cells into the breast Dr. Randall Feingold injects individual droplets using a special cannula and technique which sprinkles the donor fat into the subcutaneous fat layer under the breast skin, but not into the center of the breast gland. The fat becomes an integral part of the breast volume adding a naturally augmented look to the breasts.  Injecting an excessive amount of cells will result in necrosis (death of fat cells) because there is not enough blood supply to maintain their survival ,says Dr. Randall Feingold. 

Scars and recovery

 Fat injection with cannula results in little to no scarring – there is only a small access point where the cannula enters the breast. 

Recovery time is usually 1-2 days, however if additional procedures were administered at the same time, (such as breast implant removal or breast lift) recovery time is prolonged and can last 1-2 weeks. 

 Benefits & possible risks of Fat Transfer

 1. Safety of the procedure

While fat grafting to the buttocks can be dangerous if the fat is improperly injected under the gluteus muscle (fat embolism to the heart, lungs and death), fat grafting to the breast carries relatively little risk. There are no similar large veins in the breast to carry the fat away from the breast. 

Published in PubMed this research titledFat Injection to the breast: technique, results, and indications based on 880 procedures over 10 years investigated the fear that breast augmentation with autologous fat could lead to the formation of calcifications and cysts that might hinder mammographic examinations for detection of possible breast cancer. Research conclusion was that because of a low complication rate and positive results, it presents a new option for plastic, reconstructive, and aesthetic surgery of the breast. 

Pre- and postoperative examination by a radiologist specialized in breast imaging is necessary to limit the risk that a cancer may occur coincidentally with lipomodeling.

2. Fat retention over time

After a 2- week period to allow for blood vessel ingrowth, the surviving fat should be stable for a lifetime. According to Dr. Randall Feingold fat retention ranges between 50-70% of the fat cells given that the procedure was done according to the ASPS guidelines and with proper technique and tools.

3. Asymmetry of the breasts

In some cases fat retention is not equal on both sides – in that case more fat graft can be added to a smaller breast to improve symmetry to a larger breast. 

4. Oil cysts and fat necrosis

 It is possible that injecting large clumps of fat graft will result in fat that does not get blood supply to remain soft. This can result in firm nodules (fat necrosis) or oil cysts that can be felt under the skin. Small cysts can be drained with a needle, larger nodules may need to be removed by excision for comfort.

5. Deformation of the donor sites due to a bad liposuction

 Randall Feingold, MD explains that harvesting fat from donor sites such as the abdomen, hips or inner thighs should be done respectfully to avoid a secondary abnormality in these areas. Overly aggressive suctioning especially in thin women can cause unnecessary irregularities and indentations in those donor sites. Problems as such are more likely to stem from the surgeon’s technique or overzealous efforts rather than from the procedure itself. 

6. Screening for breast cancer

 Randall Feingold, MD works with radiologists with dedicated breast cancer screening practices. He notes that these radiologists are familiar with the appearance of fat graft on mammograms and sonograms and do not confuse this with abnormalities of breast tissue such as atypia and carcinoma. There has not been any reported instances of breast cancer related to fat grafting in the literature. 

7. Impact of weight loss and weight gain to the Breasts

After fat transfer breast volume will fluctuate with weight gain or weight loss. Also depending on the desired size and shape of the breast, one may have to have multiple fat grafting procedures with several months waiting period between stages. 

8. Dealing with  a new Body Image

Acceptance of smaller breasts after explant and Fat transfer involves an emotional adaptation, more about it in the paragraph addressing emotional and mental changes..

9. Addressing the Myth that Liposuction causes Weight gain

Women who have large amounts of fat removed from their donor sites (belly, thighs or flanks) fear mistakenly that liposuction in one area CAUSES the body to store fat in other areas. Dr. Feingold explains that this could not happen unless someone simply gains weight for the usual reasons. “If one were to gain weight after liposuction, all the fat cells in the body will enlarge, so it will be more noticeable in areas that did not undergo liposuction”. Donor sites should be carefully chosen prior to surgery to ensure that thinning of those areas adds value to the overall procedure. Most women are happy with their new shape!

10. Addressing emotional and mental adjustments

While Fat transfer following breast procedures gives hope and dignity for women seeking to improve their breast aesthetically, it is not always the case. Amanda Savage Brown, PHD LCSW is a clinical psychotherapist who Specializes in helping women find their way before, during, and after breast implant removal. She explains: 

There is an ongoing mental and emotional adjustment after breast implant removal. It can be quite challenging because explant doesn’t remove the part of your mind that cares about how you appear. So distress naturally shows up when any procedure including fat transfer doesn’t work out well for you or comes with its own surprises. For example, depending on how much fat is retained, it can be disheartening to watch your breasts’ volume decrease over time, especially when it reveals contour distortions that you hoped to avoid”Moreover, it can be emotionally draining to adjust to another procedure – related changes in your body’s appearance when you are also adjusting to your post-explant chest. 

Responding with genuine self-compassion helps, such as validating your disappointments and unexpected outcomes. It’s also important to learn new ways to respond to the part of your mind concerned with your appearance, especially when it leads to unhelpful suffering.

Final Note

When compared to the alternative of silicone or saline implants, Fat Transfer provides a better and safer alternative for  breast augmentation. 

Women who are considering options for breast enlargement deserve proper education which includes viewing all the available alternatives including Breast Lift and Fat Transfer. Information and awareness can help them make a better choice.











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