Autologous Breast Augmentation

The History of Fat Grafting to the Breast

While autologous breast augmentation using fat transfer is sometimes touted as a revolutionary, new technique for breast enlargement, fat grafting is not a new concept. In fact, the use of autologous fat to enhance the breasts dates back to 1895, when German doctor Karl Czerny, grafted a fatty tumor from a patient’s lumbar region (lower back) to repair a breast defect. Others adopted this method throughout the years and during the 1940’s and 1950’s, breast augmentation using fat grafting was commonly performed. However, complication rates were high and extensive reabsorption of the transplanted fat over time made the procedure somewhat unpredictable and controversial amongst the medical community.

Fast-forward to the 1980s when liposuction first became widely available, and interest in free fat grafting for autologous breast augmentation was quickly reignited. The advent of liposuction made extracting fat from the body much easier. In 1984, Mel Bircoll M.D. developed the micro injection technique of fat graphs using liposuction techniques. The introduction of this method allowed more surgeons to offer their patients fat transfer for aesthetic purposes, like breast augmentation.

Early Controversies of Breast Augmentation via Fat Transfer

Despite the improvement in fat extracting techniques in the 80’s, autologous breast augmentation remained controversial and debated. In 1987, the American Society of Plastic Surgeons (ASPS) issued a strong statement against the use of fat transfer for breast augmentation, citing the risk of difficulties in early diagnosis of breast cancer. This denouncement referred to the possibility of cyst formation, indurations, and fat necrosis as a result of fat injections in the breast that could be mistaken for cancerous calcifications during breast cancer screenings. Lack of research on the technique, the degree of fat reabsorption and unpredictability of the injected adipose tissue were all contributing factors to the stigma that surrounded autologous breast augmentation at this time as well.

Autologous Breast Augmentation Today

Today, the view of the ASPS on autologous fat grafting has shifted to "a promising and clinically relevant research topic." However, using fat grafting for cosmetic breast augmentation alone is still somewhat controversial. While autologous breast augmentation is slowly gaining acceptance within the medical profession, many cosmetic and plastic surgeons still will not perform this surgery. These physicians argue that the procedure is not sufficiently reliable since fat injections have a high chance of being reabsorbed into the body or potentially calcifying into a hardened mass. Most plastic surgeons continue to use breast implants for aesthetic breast augmentation, which are backed by more research and provide consistently reliable results for this type of procedure.

However, there are some surgeons making strides using this technique. Dr. Roger Khouri for example, is a well-known name in autologous breast augmentation. Dr. Khouri developed a technique known as the BRAVA system, which requires the patient to wear a vacuum pressure device to expand the breasts over several weeks. This expansion causes the woman’s body to enlarge the breast tissue, creating more space to transfer larger amounts of fat to multiple areas in the breast. So far, those who have undergone this procedure seem to have lower fat loss ratios, purportedly showing an average of 85% survival rate of the transplanted fat.

Yet, much remains to be seen with this technique, as it is still in its infancy. At this time, there simply is not enough substantial, credible research backing this method for it to compete with traditional breast implant augmentation.

Fat Grafting for Sculpting the Reconstructed Breast

While the use of fat transfer for cosmetic breast augmentation remains controversial, its use as a supplemental procedure for breast reconstruction is considered safe and effective. Fat grafts can be an excellent method for sculpting and refining the results of breast reconstruction surgery.

Dr. Spiegel often uses fat grafting as a contouring aid with implants and free flaps to improve the shape and symmetry of the reconstructed breasts. Complementary fat grafting can also give the breasts a more natural look and feel, resulting in higher patient satisfaction.

In addition, fat injections actually help radiated tissue, as radiation treatment often causes decreased blood flow and scarring in the tissue. Transferring new fat to this area can actually help increase circulation, soften the tissue and improve the quality of the skin.

The Future of Breast Fat Grafting

In summary, fat transfer to supplement breast reconstruction is a widely accepted procedure. Injecting fat after reconstruction to improve implant wrinkling and dimpling and repair breast defects and contour problems has proven to be a safe and effective technique. However, more long-term data and clinical trials are needed to substantiate the efficacy and safety of autologous breast augmentation for cosmetic purposes. With more research down the road however, it is very likely that this technique will eventually have wide application in the future of cosmetic surgery.