Fat grafting is a highly versatile technique that I have been using more and more over the last few years. The basic concept of fat grafting consists of three parts: In the first step, liposuction is used to remove diet resistant fat from areas where it is not wanted (such as the love handles and/or inner thighs). In the second step, the liposuctioned fat is processed to purify the fat cells and remove unwanted fluid, fibrous tissue, and other materials that could elicit an inflammatory reaction. (I use a device called Revolve to purify fat for grafting, where the fat is never exposed to the outside environment and can be reinjected quickly to minimize its time outside the body). In the third step, the purified fat is reinjected in places where more padding is needed, such as the upper breasts or anywhere an irregularity is present. By injecting fat in multiple threads into a patient’s tissues, each thread receives blood supply and survives as a graft. With the process I use, I find that approximately 80% of what I inject stays.
Why is fat so great? In appropriate patients, fat is the ultimate padding. It is natural and doesn’t require maintenance or replacement, it is soft and pliable, stem cells in the fat have a rejuvenating effect on the overlying skin, and the fluid-like nature of the fat allows it to be molded and injected where it is needed most.
The main reasons I use fat grafting are for adding additional upper breast fullness in patients that need a lift and want a more “augmented” looking breast without implants, and for patients having revision breast augmentation when implant rippling or irregularity needs to be camouflaged. In both of these situations fat can be an extremely helpful tool to create a soft, natural and youthful appearing breast.
There are limitations to fat grafting. Occasionally, patients do not have enough fat to harvest for a successful result, although this problem is fairly uncommon. Also, a limited amount of fat can be grafted at one time due to blood supply issues, therefore fat is not a great replacement for larger breast implants. Finally, grafting as an alternative to implants is not as successful in patients with naturally tight tissues unless preoperative stretching of the skin is performed with the Brava system. The Brava system is essentially two huge suction cups that are attached over the breasts hours a day for weeks before surgery. This system is uncomfortable to wear and a major inconvenience, and as a result I feel that it is not a reasonable alternative to straightforward breast augmentation.
Despite some of these limitations, I believe fat grafting represents one of the great new tools in aesthetic breast surgery. Please check out the new (and growing) fat grafting section on my websites to see some cases where fat helped me achieve the best possible results for my patients!
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