Woman measuring breast size with yellow measuring tape on room.

It sounds like every woman’s dream, right?  Instead of implants, simply take some fat from her thighs or tummy or love handles and transplant it into her breasts.  Voila!

Well, it’s not quite that (pardon the pun) … cut and dry.  Yet.  But after going to the ASPS (American Society of Plastic Surgery) meeting in Denver, Colorado, I’m here to report that there are more rapid advances in fat grafting, especially in breast augmentation.

I have been asked by some of my patients about this, as well, and the main question is – Is it possible to have a breast augmentation with your own fat?  And is the procedure ready for prime time?

Are you Fat Enough?

Preparing the Breasts

Fat Processing

Post-Surgical BRAVA Time

Fat Grafting Risks

Are you Fat Enough?

Essentially, to do fat grafting for breast augmentation, you have to be a good candidate.  To be a good candidate, you actually need to have enough fat to graft.  This is one of the limitations of this technology.  And before you think that you are definitely a good candidate because you have plenty of fat, consider this:

The amount of fat you need varies, but typically you need anywhere from 2 to 10 mL of raw fat to produce 1 mL of fat that has been successfully processed for injecting.  For a typical 300cc breast implant or fat grafting, that’s about 600cc  of fat to harvest –  or about 1.2 pounds of fat.

You may think you have that much fat, but trust me, that’s a decent amount of fat to do liposuction on.  And, that’s only for 1 breast.

While you may think that you certainly have at least 3 pounds of fat to donate to your breasts, you probably don’t have it all in one spot.  It is usually spread out in various areas around your body and not able to be harvested with liposuction.

The other problem, of course, is whether you actually have enough fat to inject in both breasts.  Even if you have some fat, it requires a fair amount of fat to have the equivalent of a 300 to 400 mL implant.

Preparing the Breasts

To have a successful fat grafting breast augmentation, you do have to prepare your breasts.  No, I don’t mean having an honest talk with them about what is about to happen.  I mean preparing the skin and breasts tissue to receive the fat.  This is typically done with the BRAVA medical device.

I have written another post about BRAVA in my blog and, essentially, I am not a huge fan of it.  However, it has been shown to work to prepare the breasts before fat grafting.  The Brava system is composed of 2 large plastic bubbles that are placed over your breasts, and then suction is applied to cause the skin to stretch and breast tissue to grow.

You have to wear the Brava device for approximately 6-10 hours per day, every day, for 3 weeks, before your date in the operating room.  Other plastic surgeons have tried to simply fat graft the area of the breasts and what they found is that the skin does not stretch enough to accommodate the fat.

So, even if you have enough fat in the right areas, you may still need to endure some substantial inconveniences before your surgery.

Fat Processing

The next step of the journey involves the actual processing of fat.  Assuming you have enough fat, liposuction is performed, the fat is processed and then the purified fat is then reinjected back into your breasts.

This is technically not creating stem cells or using stem cells (procedures labeled “stem cell” seem to be all the rage but are largely still just fancy marketing).  Rather, we are simply using your own fat and injecting it back into a different area of your body.  Since this fat is your own, it cannot be rejected.

Possible Post-Surgical BRAVA Time

You may need to use the BRAVA system yet again after the surgery.  Since fat grafting for breast augmentation is a newer technology, some plastic surgeons seem to recommend it to encourage the fat and breast tissue to expand and others do not.

Fat Grafting Risks

Like any surgical procedure, there are some risks involved.  Here are some that are specific to fat grafting:

The fat may atrophy or be absorbed into the body.  This really depends on your unique body and how it responds to the procedure, which is largely unpredictable.  It may also depend on which fat processing system is used.  But basically, the technology is still new enough that end results are not very consistent.

There is a risk of calcification, where the fat that is grafted can scar.  On a mammogram, these areas of scar tissue appear to be the possible visible signs of an early breast cancer.  The calcification itself is not breast cancer, but it can be perceived that way in a mammogram.  The actual risk of this happening seems to be extremely low to nil, but it has been raised by other physicians and other plastic surgeons, especially plastic surgeons that do a fair amount of breast reconstruction for breast cancer.

People have brought up the fact that there is theoretical risk of cancer due to the fact that you are transposing fat cells from one area of the body to another.  From my understanding of genetics, this risk is probably remote to nil, but appears to be a possible risk if stem cells are used.  Again, with stem cells, there have been no studies in humans that have shown that injection of human stem cells has resulted in breast cancer.

So, is fat grafting for a breast augmentation for you?  Assuming you have enough fat to graft, you are willing to undergo preparation with the BRAVA system before and after your fat grafting procedure,  and assuming that you do not need that much fat for your breasts, then you may be a good candidate.

These proverbial “hoops to jump through” may be why this procedure is not on every street corner in America –  yet.


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