Fat grafting continues to be a tremendously popular modern procedure for patients and surgeons alike. For patients, the magic of having unwanted fat in bodily areas removed and added to areas where they would benefit from volume is huge. For surgeons, fat is an incredible tool used to add nuance and “finish off” procedures, as well as, in some procedures, outright recontouring a body with just a patients’ own fat.
Questions abound from patients on how far surgeons can take fat. A popular one poses whether it is possible to skip out on implants and utilize fat exclusively for breast augmentation. Board certified plastic surgeons Dr. Christine Hamori of Boston and Dr. Brad Calobrace of Louisville discuss the possibilities.
What is Fat Grafting Again?
Fat grafting is sometimes known as fat transfer, a name that describes the technique quite literally. “Fat grafting is when you transpose fat from an area where you have a good amount of cells to an area that you don’t have so much fat,” explains Hamori. “You can very carefully put in a strands of fat so it can be vascularized and live in a different spot in your body.”
The word “magic” is often utilized when discussing fat grafting considering, for patients, the idea of moving fat from one area to another is a dream scenario. Some patients may not even be aware of the possibilities, and may receive a pleasant surprise when their surgeon offers to utilize the fat removed via a small liposuction procedure to boost other areas. This has gotten many patients thinking about other possibilities, especially those associated with the breasts. If it’s possible to recontour and add volume to the buttocks with fat, why not the breasts?
Modern Breast Augmentation and Fat Grafting
Breast implant technology has grown alongside fat grafting in the modern tool chests of plastic surgeons. More options and variability are achieving more individualized results than ever before – results that may last for decades and decades. Still, some patients are concerned with the idea of implants in their bodies and begin to wonder if they can skip implants all together in favor of volume from fat. “My strong opinion is, the still gold standard for an augmentation is a breast implant,” shares Calobrace. “It still does the best, it has the best variability – they can make sizes much bigger than fat grafting can. They last a long time; patients can maintain their implants for many years, often 15, 20, 25 years, with really low complication rates. And with, relatively, a guaranteed result.
Patients looking to dodge implants are often more of the middle-aged crowd, says Hamori. They’re thinking a bit harder about potential surgeries, and perhaps their maturity has them more cautious about the idea of implants. They may read headlines about breast augmentation with fat and think it is possible, and hope to find a surgeon who agrees.
Unfortunately, it is a double-edged sword for this age group; their maturity and age is also made known in their tissues, which have aged and seen volatility and abuse from pregnancies and life in general. Because their breasts aren’t as perky as they once were and because time has thinned and stretched their tissues, more help needs to be employed to achieve desired results. In the vast majority of cases, this involves designing a procedure around an implant that provides structure, something fat does not. “They come in asking for their fullness back,” shares Hamori. “They don’t realize they’ve had kids, their breasts have been stretched out – fat is just too loose, it’s not going to give them the shape that they want.”
The Marriage of the Two is Where Magic Happens
While some breast augmentation procedures may potentially be achieved with fat alone, the conditions would have to be very unique – meaning a patient has great shape and tissue strength but may just need a boost. For the vast majority of breast augmentation patients, an implant will be necessary. That said, fat grafting can be utilized as an incredible adjunct to the procedure.
“I think that fat grafting, or fat – we used to think of as bad. Today we think of fat as good, and we use fat a lot,” says Calobrace. “I think using fat grafting in breast surgery is great. Not as a stand-alone, but as an adjunct, either to someone who is having augmentation, or using it to correct problems with breast implants.”
The cases in which fat could greatly benefit breast augmentation are many. Thin patients may have their implants “smoothed” by adding fat to make them flow better with their chest, congenital breast deformities can be managed with small additions of fat, and even cleavage can be increased. For post-op patients who have small issues down the line, a dose of fat may help to correct these issues, whereas before, surgeon and patient may have opted for a revision surgery or implant removal.
Fat grafting is revolutionary; patients just need to understand its place in plastic surgery, as well as its limits. If an implant is providing the core structure and volume, then think of fat grafting as a surgeon coming in to “round everything off,” adding fat here and there to take a more general augmentation and turn it into something full of nuance. While patients are still coming to understand the possibilities, surgeons’ excitement at what fat grafting offers their tool chest continues to skyrocket.