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Surgery to Lose Fat, Get Bigger Breasts?

Breast Augmentation With Fat Grafts Shows Promise, but Questions Remain, Plastic Surgeons Say

Breast Augmentation With Fat: Concerns continued...

"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.

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