Autologous fat transfer, or fat grafting, uses a person’s own body fat to enhance the size and shape of the breasts. This technique involves moving fat cells from a donor area, such as the abdomen or thighs, to the breast area. The appeal of this approach is that it utilizes natural tissue, resulting in a softer feel and appearance than traditional implants. Fat transfer is a viable option for individuals seeking a moderate increase in breast volume or contour refinement.
The Procedure Steps
The procedure involves three stages designed to maximize the survival of the transferred fat cells.
Harvesting
Fat is carefully removed from a donor site, such as the flanks, abdomen, or inner thighs, using specialized liposuction. Small cannulas and low suction pressure are used to gently extract the fat, preserving the integrity and viability of the fat cells.
Purification and Processing
This stage is performed immediately after harvesting. The collected material, which contains fat cells, blood, and other fluids, is placed into a centrifuge. This device spins the material at high speed, separating the intact, viable fat cells from the excess fluids and damaged cells, which are then discarded.
Placement
The final stage is placement, where the purified fat is injected into the breast tissue through tiny incisions. Using a micro-injection technique, the surgeon places small amounts of fat into multiple layers throughout the breast tissue. This multi-layered distribution ensures that each parcel of transferred fat has adequate contact with the surrounding tissue to establish a new blood supply for long-term survival.
Determining Candidate Suitability
Ideal candidates possess sufficient excess fat in donor areas, such as the abdomen or thighs, to allow for adequate harvesting. This is necessary because the procedure requires removing more fat than will ultimately be injected due to expected cell loss. Individuals must be in good overall health, maintain a stable weight, and be non-smokers, as smoking negatively impacts the fat cells’ ability to survive.
The desired outcome is another determining factor, as fat grafting is best suited for patients seeking only a modest increase in breast size, usually limited to about one cup size. This technique is not appropriate for those seeking a significant volume change, which is better achieved with implants. A good candidate also has breast tissue with reasonable skin elasticity to accommodate the new fat volume without excessive tension. Subtle enhancements, such as correcting minor asymmetries or improving contour, are excellent applications for this procedure.
Understanding Volume Limitations and Fat Survival
The most significant constraint of fat grafting is the limitation on volume increase and the unpredictability of fat survival. Transferred fat cells must successfully establish a new blood supply in the breast tissue to survive permanently. A certain percentage of the injected fat is naturally absorbed by the body in the first few months following the procedure.
The permanent retention rate for transferred fat ranges between 50% and 80%, depending on surgical technique and the patient’s biology. Injecting a large volume in a single session can overwhelm the tissue’s ability to supply blood to the new cells, leading to fat cell death. Surgeons must limit the amount transferred per procedure to ensure the highest rate of fat survival. Patients desiring a larger increase may require multiple fat transfer sessions, spaced several months apart. Once the fat has integrated and survived the initial healing phase, it behaves like any other body fat and will fluctuate in volume if the patient gains or loses weight.
Safety Considerations and Recovery
Fat transfer breast augmentation is considered safe, but risks exist related to fat cells that do not survive. Dead fat cells can lead to the formation of oil cysts or microcalcifications. Oil cysts are benign fluid-filled sacs, while microcalcifications are small calcium deposits visible on a mammogram.
A primary concern is that these calcifications can sometimes be indistinguishable from those caused by early-stage breast cancer on a standard mammogram, potentially leading to additional testing. Surgeons mitigate this risk by carefully injecting the fat in a diffuse, multi-layered pattern. Patients must inform their radiology center about the prior fat transfer procedure. Recovery involves managing two surgical sites: the donor area requires a compression garment, and the breasts must be protected from external pressure to promote fat survival. Patients should avoid lying on their stomach and refrain from wearing tight bras for several weeks.