The Surgeon Minute

A Total Game Changer – Fat Grafting to the Breast

A Total Game Changer – Fat Grafting to the Breast

Fat grafting to the breast is revolutionizing the way in which plastic surgeons approach breast augmentation. Dr. Bruce Van Natta of Indianapolis, IN is an innovator in the field of breast surgery. For him, fat grafting to the breast has simply become a routine.

Part of the reason for this is that fat grafting is so versatile. It can be used alone in place of an implant to pump up a patient’s breast volume. It can also be added on top of an implant to increase soft tissue coverage and upper pole fullness. For tubular breasts, it has been and continues to be a total game changer. Dr. Van Natta walks us through the many pros and a few cons of fat grafting to the breast.

Fat Grafting to the Breast Is a 2 for 1

When Dr. Van Natta first started in practice 25 years ago, patients would come in to discuss a breast augmentation and joke with him about why couldn’t he just take the fat out of their butt or stomach and put in in their boobs? Well, now he can.

One of the nice things about fat grafting of any kind including fat grafting to the breast is that it’s a 2 for 1 procedure. In order to harvest the fat, it has to be taken, via liposuction, from a part of the body where you have too much, such as the:

  • abdomen
  • outer thighs
  • buttocks

Since the breasts work in harmony with the rest of the torso, this 2 for 1 approach allows a plastic surgeon to re-contour the entire body in addition to increasing breast volume.

Fat grafting to the breast - cannula.

Benefits of Fat Grafting to the Breast

There are many benefits to using fat grafting to the breast to increase breast volume, including:

  • no implant
  • no chance of your body rejecting the fat
  • it’s completely natural and feels natural

Despite the fact that breast implants have come a long way and the complication rates are very low, any time that you put a foreign device in your body things can go wrong. However, with fat grafting to the breast, you don’t have to worry about developing something like capsular contracture. This is a huge plus for many patients. Furthermore, breast tissue is already made up of glandular tissue and fat.

Results of fat grafting to the breast.

Limits of Fat Grafting to the Breast

Fat grafting to the breast does have some limits. With a 300 cc implant, “you can take it to the bank and you have exactly 300cc,” says Dr. Van Natta. Fat is not as predictable. First of all, a plastic surgeon is limited by how much volume the body can accept. Dr. Van Natta always tells patients, “you can’t put ten pounds of potatoes in a five pound sack. It just doesn’t fit.” Fat grafting to the breast is not going to be the best option for a small breasted patient who wants significantly more volume. Second, patients can expect half of the volume that’s initially placed to go away because some of it is fluid from the liposuction and not all the fat cells are going to live.

The surgeon needs to anticipate this and manage expectations before the procedure. As Dr. Van Natta explains, it can be “a little mean.” The patient gets to see this initial pump up in volume, but then has to watch the breasts deflate as the cells die off and the swelling subsides. However, as long as the patient is well prepared for this fact, it isn’t a problem. It is also really easy to go back in later and add a little more fat if needed.

Fixing Asymmetry with Fat Grafting to the Breast

No two breasts are exactly the same. One of the nicest things about a breast augmentation of any kind is that it is an opportunity to improve or fix any existing asymmetry by putting more fat or a larger implant in one side than the other. With fat grafting to the breast, patients will sometimes ask, “What if it takes on one side and not on the other?” For Dr. Van Natta, he has never seen this happen.

Fixing tuberous breasts with fat.

Fat Grafting to the Breast & Tuberous Breasts

For patients who are not wanting a huge increase in volume, fat grafting to the breast can be a stand-alone procedure. In those cases where a patient wants a bit more “oomf,” it can also be combined with an implant. This is referred to as a composite breast augmentation. An area where this has really made a difference is in patients who have tuberous breasts.

Tuberous breasts have a constricted base or lower pole. It creates a odd looking shape that has, historically, been extremely challenging to treat. They need volume, but they also need soft tissue cover. Van Natta will start off doing a fat grafting to the breast procedure. Then, later, he will go back in and either add more fat or slip in a small implant to finish things off. “Some of these results are just amazing,” he shares.

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