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Breast Augmentation Results Are "Satisfying" Using Autologous Fat

Cosmetic Surgery Times - May 1998
By Paula Moyer, Contributing Editor

Lynwood, WA - For years, women have asked cosmetic surgeons, "Can you take some fat from down there and put it up here?"

Autologous fat now works well enough as a breast augmentation that the answer is now "yes" , says Robert W. Alexander, MD, DMD, in private practice in Lynwood, WA, and holds a faculty appointment in the Department of Surgery, University of Texas Health Science Center, San Antonio, TX.

"The use of fat transfer provides us with an alternative method of breast augmentation that uses no foreign implant materials, "he says." With proper patient selection, fat grafting has the potential of producing an outcome that is as satisfying to patients than other alternatives currently available for breast augmentation."

In an interview with Cosmetic Surgery Times, Dr. Alexander discusses his experience with autologous fat in breast augmentations and the results in patients during a clinical trial studying the safety and efficacy of fat transfer.

In the intial trial, there were 70 participants having no history of previous breast surgery biopsies or breast implants. The study protocol required that they have no personal or family history of breast carcinoma. Each patient was restricted to minimal ptosis and ranged in age from 21 to 45 years.

When transferring the fat, Dr. Alexander places it retroglandularly only, in the plane occupied with the natural breast fat tissue.

Average transfer volumes in the initial trial were limited to 150cc, including saline and fat graft. Attempts to transfer only clean and intact mature adipocytes were made.

Prior to transfer, the breast were marked into quadrants using the nipple-areolar complex as the center, and the specific volume of fat transferred was recorded for each area. Minor preoperative asymmetries were addressed by varying the volumes placed in the various locations of the fat grafts.

In all cases, freshly harvested fat was utilized. Each of the patients was followed with preoperative baseline mammograms at 1 and 2 year intervals. The women's progress was charted by different radiologist, each at the same medical center where the preoperative surgery was performed. To avoid prejudicing their opinions, the radiologist were not informed of the participant's breast augmentation procedures.

"Approximately 3% to 4% of the participants had evidence of small fat cyst or spherical calcifications, which were easily differentiated from neoplastic changes," Dr. Alexander says. "We were concerned about the incidence and severity of microcalcification, and whether the transfer of fat could increase the risk of masking breast cancer." However, he adds, participants' mammography reports showed radiologist were able to differentiate the cystic or calcification changes and to detect substantial increases of retroglandular fat, with changes easily differentiated from malignancy.

"We saw no greater incidence of calcification than with other breast procedures, "says Dr. Alexander." In the study, the complications were minimal, showing no incidences of infection, hematoma, seroma, loss of sensation , increased lumpiness, or asymmetries." An estimated 60% to 70% of the transferred fat volumes were retained after the transfer.

Saline Augmentation
Breast augmentation by fat transfer is not for every patient, he notes, because limited amounts of fat can be implanted per session in order to maximize graft "take" and achieve the necessary nutritive and support needed. For example, a women wishing to augment from an A cup to a D cup would be best served by saline implants, he said. In the clinical trial, the average breast enlargement retained long-term was between 1 and 1.5 cups.

"Those patients most satisfied with breast augmentation with fat transfer were those who wished to address post-partum loss of fullness and mild droopiness, and whose goals were restoration of their prior shape and cleavage. Those who presented with the greatest amount of retroglandular fat preoperatively seemed to retain a higher proportion, "he says." While patients in this study were offered 6 months apart, only one-third requested a second transfer. The remainder achieved their personal goal after one transfer."

Taking advantage of the even vacuum pressures offered by the syringe, rapid fluctuations of pressure seen at the tip of the machine cannulas can be avoided. Such pressure fluctuations probably cause damage to surrounding cells, thereby losing viable fat cells during harvest. The syringe vacuum operates without air in the system, and is thought to harvest mature lipocytes that are less traumatized and healthier, explains Dr. Alexander.

"Optimal locations from which to harvest fat are the 'primary' deposits sites, i.e., those anatomical areas that tend to be generally determined to be the first place weight goes on and the last place it comes off," says the physician. "Those cells are believed to have donor site 'memory.' This property enables fat cells to maintain storage capabilities with greater ability than natural retroglandular breast fat." CST.