May 6, 2008 (San Diego) --Transferring fat from the buttocks, hips, and thighs to augment the breasts may sound like pure fantasy to many women.
But the technique -- known as breast enhancement with fat grafts or lipoaugmentation -- is reality and shows promise, according to a panel of plastic surgeons speaking Saturday at the annual meeting of the American Society for Aesthetic Plastic Surgery in San Diego. Even so, they acknowledge that some concerns and questions remain to be resolved.
In addition to enhancing the breasts, the fat transfer technique can also help soften the edges of breast implants for more natural-looking breasts, improve the appearance of a breast reconstructed after a mastectomy, and help correct congenital breast deformities.
"It has a lot of amazing uses," says Sydney Coleman, MD, a New York City plastic surgeon with expertise in fat transfer techniques. Coleman, who was a speaker at the meeting, cautioned that the technique's success depends very much on the physician performing it.
There are other concerns about using fat grafts for augmentation, including questions about the long-term safety and effectiveness of the grafts and whether the injected fat makes breast cancer harder to detect on mammograms. When used for enhancement, the grafts typically add a cup size or less, which may not satisfy some women.
Breast Augmentation With Fat: The Technique
Fat cells are suctioned from one part of the body -- such as the hips or thighs -- and injected into the breasts with dozens of small injections.
"Each parcel of fat needs to be close to a blood supply" so the fat cells don't die, Coleman says.
Another option, also discussed at the meeting, involves the use of the Brava breast enhancement system followed by fat injections. A woman using the Brava system wears semi-rigid domes over the breasts for multiple hours each day for several weeks, with tension-induced growth of breast tissue the goal. Next, the fat injections are done to further increase the size.
Breast Augmentation With Fat: Specifics
Breast enhancement with transferred fat can cost $20,000, Coleman says. He acknowledges it's much higher than what is charged for breast augmentation with implants, but notes that it's actually two procedures.
The average surgeon's fees for breast augmentation is about $4,000 and for liposuction about $3,000 (plus facility fee and anesthesia charges), according to the American Society for Aesthetic Plastic Surgery.
How long the transferred fat will last is another unknown, he says, and will vary from one person to another. Doctors don't expect it to replace augmentation.
Breast Augmentation With Fat: Concerns
Even though fat grafting has been in practice for more than 20 years -- with surgeons now often using it to improve the appearance of faces and hands -- injecting the breasts for enhancement has sparked concern from some.
"We know there are negatives to this," says Scott Spear, MD, chief of plastic surgery at Georgetown University Hospital in Washington, D.C., and another speaker on the panel. Chief among them is the concern that cancer might not be detected on a mammogram.
In 2007, The American Society of Aesthetic Plastic Surgery and the American Society of Plastic Surgeons issued a statement of caution about fat grafting to the breast, concluding it is not recommended for augmentation because of the lack of data and the possibility of hampering the detection of breast cancer. According to the statement, the procedure can be effective to enhance breast appearance after reconstruction, to soften the appearance of implants already in place, or to rejuvenate the hands and face.
Among the potential risks of using fat grafts for augmentation, according to the societies, is death of the fat cells, calcification, or the formation of cysts or scars, the latter perhaps making it difficult to detect cancer on a mammogram.
Fat Grafting: Addressing the Concerns
In a study published in Plastic and Reconstructive Surgery in 2007, Coleman reviewed 17 breast procedures using fat grafting, performed from 1995 to 2000. The grafts were used to correct congenital defects, deformity after implants, or to improve the appearance of reconstructed breasts.
He found that the post-op mammograms "identified changes that one would expect after any breast procedure" and that the technique should be considered an alternative or adjunct to breast enhancement and reconstruction procedures.
Spear says he found the technique to be safe overall and that improvement in appearance was the norm in his study of patients who had the fat injections to improve deformities in their reconstructed breasts.
The fat grafting "is a wonderful adjunctive tool" for reconstruction after mastectomy, Spear says. In his study, reported in Plastic and Reconstructive Surgery, 37 patients had the injections in 43 breasts. The fat sometimes died and repeat injections were sometimes needed. But minimal to moderate improvement was seen in 64% of the breasts and substantial improvement in 21%, he says.
A task force assigned to study fat grafts for breast augmentation has submitted its recommendations to the American Society of Plastic Surgeons, Coleman tells WebMD. He was a member of the task force.
A statement is expected from the society later this year, he predicts.
"Until our society gives an OK in writing," Coleman told physicians at the meeting, "you are at legal risk."
Breast Augmentation With Fat: Research
Two clinical trials are focused on studying fat grafts for breast enhancement, including one led by Spear at Georgetown University.
Another, led by Roger Khouri, MD, of Brava, is testing the combination of the Brava system and fat grafts.
More study is needed on fat grafts to the breast, says William Aiello, MD, a plastic surgeon in Los Alamitos, Calif.
"There's a paucity of information," he says. "It will take another couple of years to determine exactly the best use for it."
"I think we need more confirmation from the radiologists" to confirm that breast cancer could be detected in fat-injected breasts, says Lee Colony, MD, a plastic surgeon in East Lansing, Mich., and clinical associate professor at Michigan State University in East Lansing. He has performed the procedure on a limited basis for breast reconstruction patients.