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Fat Injections for Breast and Body Contouring

What is old often becomes new again as techniques improve and better science comes to focus on a treatment; fat injections are an excellent example of this. Close to 100 years ago surgeons came up with the idea of taking fat from one area of the body and moving it as a graft to fill a defect somewhere else. These procedures typically failed for larger lumps of fat couldn’t heal in well to the new area leading to fat cell death, cysts, firmness, or infections. Still a creative approach for after the turn of the century. The advent of liposuction techniques in the 1980’s led to Plastic surgeons revisiting the ideas of injecting fat into areas of the body to correct trauma defects and for cosmetic purposes. While there were occasional successes there were still many failures and unreliable survival of the fat grafts that led to patient and surgeon disappointments. Still given the potential of fat grafting for breast augmentation, buttock augmentation, facial filling, cancer reconstruction, and traumatic contour correction has made us continue to push the envelope to make it a more reproducible technique. Many studies have now been done to look at the physiology of fat cell so we better understand how much trauma the cells can tolerate when harvested by liposuction. Studies continue to look at whether cells survive better if cleansed, or centrifuged at low speeds, or if growth factors or other agents can be added to them to make them healthier and survive in the new site they are placed.  In short, we keep learning, keep refining the techniques, and keep looking for new ways to do this better.

Stem Cells and Fat Injections

More recently the science of stem cell research has been focused on fat cells as a good stem cell line.  It turns out that fat has a higher number of stem cells than some other tissue types of the body.  Stem cell is a fancy term for a cell that has the potential to turn into different types of cells.  So a fat cell that is a stem cell might be able to turn into a muscle cell or a bone cell if the right chemical triggers direct it to change. Also stem cells have the potential to release more growth factors or other cellular chemicals that might be advantageous for tissue growth. Now I’m simplifying this in a huge way; this is very high level scientific stuff that involves DNA triggering, cell life cycles, complex growth factor chemistry, and the mechanisms of how cells “speak” to each other. Just taking a stem cell and sticking it somewhere in the body doesn’t mean it will do anything special, that stem cell needs all the right chemical triggers to behave like the “magical cell” that it can be. My own research background when I was studying General Surgery and also later with Plastic Surgery was growth factor research, collagen research, and the science of wound healing, and I still have a hard time understanding all the science of stem cells and I was in the field back in the day. Still this is very exciting stuff even though we are just beginning to crack the egg of stem cell potential. So what has this meant for fat grafting for breast, buttock, and body contouring?

First, fat grafting has been shown to be much more reliable now with correct handling of the fat and good patient selection. Second is there may be some stem cell interactions that go with fat transfer that helps with the results. This second point is still to be worked out, we must remember that the stem cells in a fat graft is an extremely low number of cells compared to the regular fat cells, and again without the right chemistry in the area those cells likely aren’t doing anything special. The jury is still out on the exact involvement of stem cells in the graft, but there is some loose evidence that it’s a good thing to have them there. So let’s revisit body contouring.

Fat Grafting and Breast Procedures

There is great interest in breast augmentation and breast reconstruction with fat grafts from liposuction. It’s critical for patients to understand that the hype is always greater than the reality, but this is still a very promising area. Breast augmentation or reconstruction with fat injections is still viewed as an “experimental” technique, but it is becoming more accepted as we study it closer. The most obvious concern is can fat grafts to the breast lead to increase risks of breast cancer or can the grafting procedures make it harder to detect breast cancer later in life. If some breast fat grafts for cysts or scar tissue in the breast it might make it very difficult for a radiologist to tell cancer from scar. As more cases have been preformed and more radiologist have evaluated patients over time post fat grafting they have not found this to be a problem. The experienced radiologist can most always tell “non-cancerous” scar tissue in the breast from the signs of cancer on a mammogram. Also as our grafting techniques get better there is better “take” of the grafts and less scar tissue to worry about. To date there has been no indication that fat grafting increases the risk of cancer occurring in those grafts, but of course it will take many thousands of patients followed for many years to get solid data on that type of topic. We have to remember that the incidence of breast cancer in the regular female population is around 10%.  If someone gets fat grafts and has a breast cancer 20 years later we really have no way of knowing that she wasn’t going to get breast cancer anyhow. One thing that remains very clear in my experience is that younger patients  have better graft take than older patients and so fat grafting has greater promise in augmentation of younger patients than perhaps patients over 40 years of age. Of course other health issues come into play also for the patient with diabetes, a smoking history, cardiac or vascular disease will have less success with fat grafting than the patient without any medical issues. Physiologic age is more important than chronologic age.  Some 50 year old are physiologically in better shape than some 35 year olds.

Fat Grafting Success Rates

In my plastic surgery practice in Tucson Arizona, I have had some young patients take fat grafts so well that I had to go back and remove some later, and I’ve had some older patients look like none of the fat stayed after 6 months or more. It’s a very mixed bag of success rates, but it keeps getting better in my hands. Patients have to be realistic and surgeons have to avoid making grandiose promises about results. Don’t let anyone tell you it works all the time, but also don’t let anyone tell you it’s not a valid technique for fat grafting works very well often.

One issue for patients considering fat grafting for breast augmentation or buttock augmentation is that tiny patients might not have enough fat to accomplish much augmentation. A very slim patient that wants very little buttock or breast augmentation might get away with it, but these patients typically need standard techniques of breast or gluteal augmentation to accomplish their desired look.  A little more heavy set patient may have more fat to harvest to accomplish filling with fat alone. Another key issue to remember though is the more fat we put in the more chance it might not take as well. Fat grafts do best as small threads of filling at many different levels and directions so the fat has the best chance of getting blood vessels to grow to them and provide nutrition and oxygen and all the good stuff that keeps a cell alive and happy.  The more fat that gets layered in next to other fat grafts the more difficult it is to get good healthy fat as the final result.  This is one of the reasons fat grafting can take a long time to do. First we have to suction the fat to be reinjected, and the technique of harvest can’t be too traumatic to the cells, then we clean the fat and “purify” to cells so the graft is more likely to have more healthy viable cells, then we have to reinject the cells into multiple spots and planes so they have the best chance of making it on the long term.  Rough rapid traumatic technique might kill more cells, it’s a delicate balance of efficiency to cell survival. We’re very excited about the current use of fat grafting and the promise of better things to come as the science is worked out better and better every year.

If you have any questions about fat grafting for the breast, the buttock region, or body contours please don’t hesitate to make an appointment for a consult with Tucson Plastic Surgeon Dr. Jeffrey Nelson at (520) 575-8400

 

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