Fat transfer
Encyclopedia
Fat transfer is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. Autologous adipose tissue transplantation has been used for breast augmentation for cosmetic reasons and after breast cancer surgery. It is a minimally invasive procedure an alternative to breast augmentation using breast implants.
In 2007 doctors from the UCLA Division of Plastic and Reconstructive Surgery wrote an article about fat transfer in which they concluded that "the literature fails to provide definitive evidence of fat survival."
However, a recently published study shows results on the quantification of volume gain after liposuction and subsequent autologous fat transfer to the breast. The prospective clinical study including 85 patients evaluated the method of water-jet assisted liposuction and autologous fat transfer for breast augmentation. The study verified a permanent take rate (volume gain) of 76±11% of the grafted fat after a time period of 6 months. The assessment of volume gain was done by preoperative and postoperative MRI spectroscopy.
physician
Franz Neuber used a small piece of upper arm fat
to build up the face
of a patient
whose cheek had large pit caused by a tubercular inflammation
of the bone
.
In 1895, another German doctor, Dr. Karl Czerny, did the very first documented breast augmentation
when he transplanted a fatty tumor
from the patient’s lumbar region, or lower back, to a breast
defect.
procedure became more widely available, fat also became much more easily withdrawn from the body
. In 1984, Mel Bircoll M.D. introduced micro injection of fat graphs, using liposuction techniques.
That development allowed more plastic, dermatological and cosmetic surgeons to offer their patients fat transfer for cosmetic reasons. Some contend that an advantage of fat transfer is that it is the patient's own tissue and, hence, not subject to rejection
by the body. Another advantage pointed to is that most other dermal fillers are absorbed by the body within three to nine months, making regular injections
a continuing expense.
Essentially, the fat transfer procedure harvests fat from one part of the body where an excess exists and then places it in another part of the body where the additional bulk is used for cosmetic and aesthetic purposes. Fat transfer—which is also known as fat grafting, fat autographs, autologous fat transplantation, fat injecting or microlipoinjections to physicians—is being used in cosmetic plastic surgery to:
that has a large-bore needle
or with a liposuction
cannula
. The fat is prepared according to the practitioner’s preferred method and then injected into the patient’s recipient site. The preparation process clears the donor fat of blood
, pain killers
and other unwanted ingredients that could cause infections or other undesirable side effects
. Moreover, some physicians have found that human fat outside the body is incredibly delicate. One researcher (Mendieta) found that, to obtain viable fat, the needle withdrawing the fat can’t be too narrow, the liposuction cannula can’t have too strong a vacuum
pressure and the centrifuge
used to clear debris
from the donated tissue can’t spin too rapidly. Another researcher found that vacuum pressure on the liposuction machine could not be higher than 700 mmHg.
A few doctors excise, or cut, small strips of fat from the body and then place, rather than inject, the tissue in the recipient site, using additional small incisions.
Other uses and applications continue to develop as surgeons work with, and learn more about, fat transfer. Some of the most current and developing applications include:
Depending on the surgeon, the patient and several other factors, the body is reported to reabsorb anywhere from 20 to 95 percent of transferred fat.
Due to the varying rates of absorption and the different lengths of time fat is reported remaining in the body, many physicians and other researchers worldwide since the 1980s have tracked success, safety and failure rates of fat transfer.
In most applications, fat injections are laid down through several different layers of skin
and muscle
to provide a better chance for the fat cells to find a nearby blood supply. Because some fat is always absorbed, most physicians inject somewhere around 30 percent too much.
Physicians have learned the best donor areas are found in:
and Juvederm
but the longer lasting method seems to be fat transfer via injection which is reported to last for years.
.
The most common facial locations for fat transfer include:
Generally, 40-60% of the transferred fat persists permanently. However, the long-term efficacy of transferred fat has been documented in numerous studies results are extremely technique dependent.
or, e-PTFE (polytetrafluorethylene) as the material is known to doctors.
implants to fill out their derrière, patients who can spare the fat can undergo fat injection in a surgical procedure known as gluteoplasty or Brazilian butt lift. Working through small incisions in each gluteal cheek, the surgeon places fat cells at dozens of levels through the patient’s rear. It’s an exacting procedure; one practitioner (Roberts) reports that a placement of fat cells the size of teaspoon
will perish because that many fat cells can’t find a blood supply. Most surgeons who perform the task say the perfect deposit of fat cells is about the size of a single pearl
or a pea
; the drops are placed in long rows. After the procedure, the patient must wear a compression garment for about six weeks and sleep on the stomach for about a week. In most cases, non-athletic activities and driving can be resumed in about five days.
and result in extremely small, narrow and sagging breasts, or to correct Polands Syndrome, a rare birth defect characterized by underdevelopment or absence of the chest muscle (pectoralis) on one side of the body. It is used to reconstruct breast deformities due to mastectomy
, a lumpectomy
, a breast implant collapse.
Many breast augmentation patients have joked that if they could magically shift fat from one area of their bodies to another, implants wouldn’t be necessary. Little do they know that each day, a number of plastic surgeon scientists are inching closer to breakthroughs in fat-derived, adult stem cell therapy that will not only revolutionize plastic surgery, but also carry the potential to reshape medical care in general.
Autologous, fat-derived adult stemcells – “mature” cells re-introduced into the same body, as opposed to embryonic stem cells used as an allograft – are showing tremendous plastic surgery-related promise for such applications as post-mastectomy breast reconstruction, aesthetic breast augmentation and cosmetic hand rejuvenation, as well as the repair of wounds, scars, burns and radiation-damaged skin.
This new micro-fat grafting procedure begins with the patient wearing the Brava bra, to prepare the recipient breast. The patient wears the Brava, while sleeping, for 3 to 5 weeks prior to the first grafting session. Not only does Brava expand the skin from the outside, it also has the effect of regenerating an edema-like breast mound through the stretch expansion of tissues and nerves. This creates an adequate vascular matrix into which the liposuctioned fat is later injected.
The procedure is done as outpatient, often under local anesthesia and sedation, and has minimal recovery time. Unlike traditional methods, it involves no incisions, no new scars or foreign objects, yet it recreates an entire, natural feeling breast.
Fat is then removed from one area of the body and meticulously injected it back as hundreds of tiny individual droplets in the breast site. These micro-fat transfer (autologous grafts) are harvested by gentle liposuction from the thighs, buttocks and stomach–wherever there is fat to spare. Even skinny patients do extremely well with this procedure.
A five year, 50 patient study (this study may not have been publicised, this study may have only been shown on the doctor's own website, which makes the study less authentic) has proven successful for Dr. Roger Khouri's break through natural breast augmentation and enhancement with fat transfer. Researchers undertook this prospective study to determine the effect of BRAVA breast expansion on breast augmentation with liposuctioned fat grafts and to establish the safety and efficacy of the procedure.
Although many doctors claim the safety of breast augmentation using fat transfer, this method is actually not passed by FDA or American regulatory agencies, please see FDA website's breast augmentation handbook or the study on the procedure: http://www.ncbi.nlm.nih.gov/pubmed/3438355
Model Katie Green
, who was chosen from among 4,000 other girls as the new face for Wonderbra
in 2011, had severely asymmetrical breasts. Her right breast was a B cup and 2 inches (5.1 cm) and two cup sizes smaller than her left breast, a D cup. In January 2001, she underwent platelet injection fat transfer which transferred fat cells from her thighs to her left breast.
Using fat transfer and the BRAVA bra, a significant amount of volume increase can be achieved with fat grafts obtained by gentle liposuction. The most important determinant of final augmentation volume is the extent of breast expansion achieved with BRAVA prior to fat grafting. The beauty of it is no incisions, no scars, and all natural results.
As Dr. Khouri refined the surgical technique, operating time for bilateral augmentation was reduced from 5 to 1.5hrs. Patients returned to their normal activities within 3-4 days.
Coleman and Saboeiro compiled statistics
on a series of fat injection breast augmentation patients and reported that improvements in the size and shape of the breasts are possible with a fat grafting technique.
In that procedure, the doctors harvest donor fat, centrifuge it for refinement and to screen out impurities. Then, in a four- to five-hour procedure, they inject the fat into the layers of the breast through six to eight, two-millimeter incisions in each breast. (One millimeter is the width of a single line drawn by a ballpoint pen.) Blunt syringes and cannulas are used to place the fat so that no damage is done to blood vessels or nerves. The fat is layered from the pectoralis major muscle
up through the top of the breast; the surgeons rely on the fat injections to shape the breasts for an aesthetic, natural-looking result.
The American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS) formerly advised surgeon members and the public against fat transfer augmentation procedure because the methods for harvesting fat cells had not been standardized and due to concerns about side effects such as oil cysts, calcification, and tissue scarring. Since then, improvements in mammography equipment and methods for harvesting and injecting fat cells have been refined and reduced the associations' concern. When compared to saline or silicone implants, they currently state that there "is little clinical evidence, pro or con, exists to suggest that fat grafting is safer or better than saline or silicone implants."
The ASPS issued a new policy paper on Fat Transfer/Fat Graft and Fat Injection on March 11, 2009. In it, the Executive Committee approved a policy paper. The paper offers background information on the applications, risks and complications, and techniques of fat transfer procedures. The paper also summarizes scientific evidence. Additionally, four guiding principles are stated, based on the conclusion that fat grafting is a safe procedure in select cases; and that results are dependent on a surgeon's technique and expertise. Indications for fat grafting included: Micromastia
; post-breast augmentation
deformity, with or without removal of implant; Tuberous breasts
; Poland's Syndrome, post-lumpectomy
deformity; post-mastectomy
deformity; deficits caused by conservative treatment or reconstruction with implants
and/or flaps (latissimus dorsi or TRAM); damaged tissue resulting from radiotherapy and nipple reconstruction. There is at least one registered clinical trial, ID:NCT00466765, currently with open enrollment.
In addition to these referenced reconstructive procedures, fat transfer was introduced for use in the high risk breast cancer patient. The patient undergoes standard bilateral nipple sparing mastectomy and liposuction. The lipo-aspirate is stored using known biological tissue storing techniques in liquid nitrogen. After a suitable healing period, the lipo-aspirate is injected in serial treatments to build to a natural contour. Given a relatively small breasted woman with sufficient donor fat, the breasts may be enhanced in size over the preoperative state.
some or all of the fat may become firm, hard, or lumpy. If some of the fat does not survive the transfer, it may result in fat necrosis (death of transferred fat tissue), causing firmess and discomfort or pain. Cysts may also form at the site of the transferred fat. Surgery may be required to improve such conditions." source: Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force Karol A. Gutowski, MD, Chair, and the ASPS Fat Graft Task Force. figure 1: INFORMED CONSENT FOR FAT TRANSFER PROCEDURES (FAT GRAFTS AND FAT INJECTIONS)
Fat transfer remains controversial although many plastic, dermatology and cosmetic surgeons offer various fat transfer procedures to their patients because the procedure is so well received by patients.
Potential risks of any fat transfer include bleeding or hematoma
, (a pool of blood forming under the skin), infection
, nerve damage or wound dehiscence, when a surgical wound opens. Sometimes, fluid collection, or seroma
, around a surgical wound happens. While all are normally easily controlled and healed, more serious complications can arise. In the case of the former Miss Argentina, Solange Magnano
, the gluteoplasty led to pulmonary embolism
, which she succumbed to on November 29, 2009 after three days in critical condition. A close friend, Roberto Piazza, was quoted as saying the liquid from the injections "went to her lungs and brain."
Overall, the survival of injected fat seems to depend on how the physician harvests the donor fat, the technique used to treat the fat and how the prepared fat cells are put back into the patient and the site to which the fat was moved. Doctors Summer and Sattler found that fat survives equally well when removed with suction via liposuction
or when withdrawn by a syringe. The issue of survivability seems most affected by where in the body the fat is transferred, how much that site moves, how muscular it is and if disease
is present.
When a large area like the buttocks is treated, the patient may have to stop normal activities for a while and can expect some swelling, bruising or redness.
In 2007 doctors from the UCLA Division of Plastic and Reconstructive Surgery wrote an article about fat transfer in which they concluded that "the literature fails to provide definitive evidence of fat survival."
However, a recently published study shows results on the quantification of volume gain after liposuction and subsequent autologous fat transfer to the breast. The prospective clinical study including 85 patients evaluated the method of water-jet assisted liposuction and autologous fat transfer for breast augmentation. The study verified a permanent take rate (volume gain) of 76±11% of the grafted fat after a time period of 6 months. The assessment of volume gain was done by preoperative and postoperative MRI spectroscopy.
Origins
Fat injection reportedly started in 1893 when GermanGermany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
Franz Neuber used a small piece of upper arm fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
to build up the face
Face
The face is a central sense organ complex, for those animals that have one, normally on the ventral surface of the head, and can, depending on the definition in the human case, include the hair, forehead, eyebrow, eyelashes, eyes, nose, ears, cheeks, mouth, lips, philtrum, temple, teeth, skin, and...
of a patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
whose cheek had large pit caused by a tubercular inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
.
In 1895, another German doctor, Dr. Karl Czerny, did the very first documented breast augmentation
Breast augmentation
Breast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...
when he transplanted a fatty tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
from the patient’s lumbar region, or lower back, to a breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
defect.
Overview of current techniques
In the 1980s, when the liposuctionLiposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
procedure became more widely available, fat also became much more easily withdrawn from the body
Human body
The human body is the entire structure of a human organism, and consists of a head, neck, torso, two arms and two legs.By the time the human reaches adulthood, the body consists of close to 100 trillion cells, the basic unit of life...
. In 1984, Mel Bircoll M.D. introduced micro injection of fat graphs, using liposuction techniques.
That development allowed more plastic, dermatological and cosmetic surgeons to offer their patients fat transfer for cosmetic reasons. Some contend that an advantage of fat transfer is that it is the patient's own tissue and, hence, not subject to rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
by the body. Another advantage pointed to is that most other dermal fillers are absorbed by the body within three to nine months, making regular injections
Injection (medicine)
An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...
a continuing expense.
Essentially, the fat transfer procedure harvests fat from one part of the body where an excess exists and then places it in another part of the body where the additional bulk is used for cosmetic and aesthetic purposes. Fat transfer—which is also known as fat grafting, fat autographs, autologous fat transplantation, fat injecting or microlipoinjections to physicians—is being used in cosmetic plastic surgery to:
- Smooth and repair aged hands
- Fill wrinkled, creased faces
- Create more shapely, curvaceous buttocksButtocksThe buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
- Enlarge breasts
Procedures
Fat is withdrawn from the patient in one of three ways: with a syringeSyringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
that has a large-bore needle
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
or with a liposuction
Liposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
cannula
Cannula
A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
. The fat is prepared according to the practitioner’s preferred method and then injected into the patient’s recipient site. The preparation process clears the donor fat of blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, pain killers
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
and other unwanted ingredients that could cause infections or other undesirable side effects
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
. Moreover, some physicians have found that human fat outside the body is incredibly delicate. One researcher (Mendieta) found that, to obtain viable fat, the needle withdrawing the fat can’t be too narrow, the liposuction cannula can’t have too strong a vacuum
Vacuum
In everyday usage, vacuum is a volume of space that is essentially empty of matter, such that its gaseous pressure is much less than atmospheric pressure. The word comes from the Latin term for "empty". A perfect vacuum would be one with no particles in it at all, which is impossible to achieve in...
pressure and the centrifuge
Centrifuge
A centrifuge is a piece of equipment, generally driven by an electric motor , that puts an object in rotation around a fixed axis, applying a force perpendicular to the axis...
used to clear debris
Debris
Debris is rubble, wreckage, ruins, litter and discarded garbage/refuse/trash, scattered remains of something destroyed, or, in geology, large rock fragments left by a melting glacier etc. The singular form of debris is debris...
from the donated tissue can’t spin too rapidly. Another researcher found that vacuum pressure on the liposuction machine could not be higher than 700 mmHg.
A few doctors excise, or cut, small strips of fat from the body and then place, rather than inject, the tissue in the recipient site, using additional small incisions.
Other uses and applications continue to develop as surgeons work with, and learn more about, fat transfer. Some of the most current and developing applications include:
- CheekCheekCheeks constitute the area of the face below the eyes and between the nose and the left or right ear. They may also be referred to as jowls. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve...
and chinChinIn the human anatomy, the chin is the lowermost part of the face.It is formed by the lower front of the mandible.People show a wide variety of chin structures. See Cleft chin....
implants - Repair of inverted nipples
- Increasing the girth of the penisPenisThe penis is a biological feature of male animals including both vertebrates and invertebrates...
Depending on the surgeon, the patient and several other factors, the body is reported to reabsorb anywhere from 20 to 95 percent of transferred fat.
Due to the varying rates of absorption and the different lengths of time fat is reported remaining in the body, many physicians and other researchers worldwide since the 1980s have tracked success, safety and failure rates of fat transfer.
In most applications, fat injections are laid down through several different layers of skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
and muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
to provide a better chance for the fat cells to find a nearby blood supply. Because some fat is always absorbed, most physicians inject somewhere around 30 percent too much.
Physicians have learned the best donor areas are found in:
- The lower stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
- The inner thighs
- The inner knees
Fat transfer to the hand
A wrinkled, bony hand with large veins, sun spots and deep grooves can reveal an advanced age even though the patient’s face, breasts or body have been surgically rejuvenated. Consequently, plastic, dermatological and cosmetic surgeons have developed techniques to make hands also look younger. A few practitioners use dermal fillers like RestylaneRestylane
Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...
and Juvederm
Juvéderm
Juvéderm , one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the faces of patients. The substance is largely hyaluronic acid, a substance normally found in the skin, muscles, and tendons of...
but the longer lasting method seems to be fat transfer via injection which is reported to last for years.
Facial fat transfer
A liposuction technique is used to harvest the fat and prepare it for transfer. The fat is then injected into the desired portion of the face. When using a micro injection technique, extremely small parcels of fat are placed into multiple layers of the face. The procedure is most commonly performed under local anesthesia with a light oral sedationSedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...
.
The most common facial locations for fat transfer include:
- Filling in sunken areas beneath the eyes
- Fleshing out the folds of skin that physicians know as nasolabial folds, the deep wrinkles next to the mouth often referred to as “laugh lines.”
- Filling in forehead creases
- Cheek Augmentation
Generally, 40-60% of the transferred fat persists permanently. However, the long-term efficacy of transferred fat has been documented in numerous studies results are extremely technique dependent.
Lip augmentation
Tiny, punch-like incisions are made at one corner of the patient’s mouth. The surgeon then takes one- to two-millimeter-thick strips of fat from the donor site and gently works them into the upper and lower lips for a plumping effect that is reported to be safer, softer and more natural than lip augmentation with popular injectable facial fillers like Restylane or filler materials like medical Gore-TexGore-Tex
Gore-Tex is a waterproof/breathable fabric, and a registered trademark of W. L. Gore and Associates. It was co-invented by Wilbert L. Gore, Rowena Taylor, and Gore's son, Robert W. Gore. Robert Gore was granted on April 27, 1976, for a porous form of polytetrafluoroethylene with a...
or, e-PTFE (polytetrafluorethylene) as the material is known to doctors.
Buttocks augmentation via fat injections
Many women, including transwomen, and a growing number of men want a curvier, rounder and shapelier rear end. While thin patients must opt for insertion of special buttocksButtocks
The buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
implants to fill out their derrière, patients who can spare the fat can undergo fat injection in a surgical procedure known as gluteoplasty or Brazilian butt lift. Working through small incisions in each gluteal cheek, the surgeon places fat cells at dozens of levels through the patient’s rear. It’s an exacting procedure; one practitioner (Roberts) reports that a placement of fat cells the size of teaspoon
Teaspoon
A teaspoon, an item of cutlery, is a small spoon, commonly part of a silverware place setting, suitable for stirring and sipping the contents of a cup of tea or coffee...
will perish because that many fat cells can’t find a blood supply. Most surgeons who perform the task say the perfect deposit of fat cells is about the size of a single pearl
Pearl
A pearl is a hard object produced within the soft tissue of a living shelled mollusk. Just like the shell of a mollusk, a pearl is made up of calcium carbonate in minute crystalline form, which has been deposited in concentric layers. The ideal pearl is perfectly round and smooth, but many other...
or a pea
Pea
A pea is most commonly the small spherical seed or the seed-pod of the pod fruit Pisum sativum. Each pod contains several peas. Peapods are botanically a fruit, since they contain seeds developed from the ovary of a flower. However, peas are considered to be a vegetable in cooking...
; the drops are placed in long rows. After the procedure, the patient must wear a compression garment for about six weeks and sleep on the stomach for about a week. In most cases, non-athletic activities and driving can be resumed in about five days.
Breast augmentation via fat grafting
Fat grafting to female breasts can be performed for cosmetic reasons, breast augmentation, to correct breast asymmetry, tuberous breast, a condition in which the adult breasts fail to develop in pubertyPuberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
and result in extremely small, narrow and sagging breasts, or to correct Polands Syndrome, a rare birth defect characterized by underdevelopment or absence of the chest muscle (pectoralis) on one side of the body. It is used to reconstruct breast deformities due to mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
, a lumpectomy
Lumpectomy
Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...
, a breast implant collapse.
Many breast augmentation patients have joked that if they could magically shift fat from one area of their bodies to another, implants wouldn’t be necessary. Little do they know that each day, a number of plastic surgeon scientists are inching closer to breakthroughs in fat-derived, adult stem cell therapy that will not only revolutionize plastic surgery, but also carry the potential to reshape medical care in general.
Autologous, fat-derived adult stemcells – “mature” cells re-introduced into the same body, as opposed to embryonic stem cells used as an allograft – are showing tremendous plastic surgery-related promise for such applications as post-mastectomy breast reconstruction, aesthetic breast augmentation and cosmetic hand rejuvenation, as well as the repair of wounds, scars, burns and radiation-damaged skin.
This new micro-fat grafting procedure begins with the patient wearing the Brava bra, to prepare the recipient breast. The patient wears the Brava, while sleeping, for 3 to 5 weeks prior to the first grafting session. Not only does Brava expand the skin from the outside, it also has the effect of regenerating an edema-like breast mound through the stretch expansion of tissues and nerves. This creates an adequate vascular matrix into which the liposuctioned fat is later injected.
The procedure is done as outpatient, often under local anesthesia and sedation, and has minimal recovery time. Unlike traditional methods, it involves no incisions, no new scars or foreign objects, yet it recreates an entire, natural feeling breast.
Fat is then removed from one area of the body and meticulously injected it back as hundreds of tiny individual droplets in the breast site. These micro-fat transfer (autologous grafts) are harvested by gentle liposuction from the thighs, buttocks and stomach–wherever there is fat to spare. Even skinny patients do extremely well with this procedure.
A five year, 50 patient study (this study may not have been publicised, this study may have only been shown on the doctor's own website, which makes the study less authentic) has proven successful for Dr. Roger Khouri's break through natural breast augmentation and enhancement with fat transfer. Researchers undertook this prospective study to determine the effect of BRAVA breast expansion on breast augmentation with liposuctioned fat grafts and to establish the safety and efficacy of the procedure.
Although many doctors claim the safety of breast augmentation using fat transfer, this method is actually not passed by FDA or American regulatory agencies, please see FDA website's breast augmentation handbook or the study on the procedure: http://www.ncbi.nlm.nih.gov/pubmed/3438355
Correcting asymmetrical breasts
Up to 25% of women's breasts display a persistent, visible breast asymmetry, which is defined as differing in size by at least one cup size. Ten percent are severely different, with the left breast being larger in 62% of cases. Few surgeons will agree to an augmentation procedure unless there is a difference of at least one cup size.Model Katie Green
Katie Green
Katie Green is an English model from Chichester, West Sussex. Green was originally signed to represent Wonderbra in July 2008, but the Premier Model Management agency immediately pressured her to lose and two dress sizes. She ended her contract in October 28 when she refused to lose weight...
, who was chosen from among 4,000 other girls as the new face for Wonderbra
Wonderbra
The Wonderbra is a type of push-up underwire brassiere that gained worldwide prominence in the 1990s. Although the Wonderbra name was first trademarked in the U.S. in 1935, the brand was developed in Canada. Moses Nadler, founder and majority owner of the Canadian Lady Corset Company, licensed the...
in 2011, had severely asymmetrical breasts. Her right breast was a B cup and 2 inches (5.1 cm) and two cup sizes smaller than her left breast, a D cup. In January 2001, she underwent platelet injection fat transfer which transferred fat cells from her thighs to her left breast.
Augmentation results
The first documentation of long-term, quantitative volume maintenance in breast fat transplantation in the English literature was published in the journal, Plastic and Reconstructive Surgery by Daniel Del Vecchio and Louis Bucky in June, 2011. In a consecutive series of 25 patients receiving BRAVA pre-expansion and fat transplantation for breast augmentation, they demonstrated a 63% volume maintenance, or a 216% increase in original breast volume, using un-adulterated fat. This fat was harvested by machine liposuction and was collected "in line" in a serile canister. It was not enriched with stem cells, platelet rich plasma, or other additives. Moreover, the standard deviation of their volume increase was only 11%, suggesting a small variation and a high reliability of the resulting volume increase. They also demonstrated their technique of "in line" machine harvesting and collection of fat, and "large syringe" technique of centrifugation reduced operative times to two hours or less.Using fat transfer and the BRAVA bra, a significant amount of volume increase can be achieved with fat grafts obtained by gentle liposuction. The most important determinant of final augmentation volume is the extent of breast expansion achieved with BRAVA prior to fat grafting. The beauty of it is no incisions, no scars, and all natural results.
As Dr. Khouri refined the surgical technique, operating time for bilateral augmentation was reduced from 5 to 1.5hrs. Patients returned to their normal activities within 3-4 days.
Coleman and Saboeiro compiled statistics
Statistics
Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....
on a series of fat injection breast augmentation patients and reported that improvements in the size and shape of the breasts are possible with a fat grafting technique.
In that procedure, the doctors harvest donor fat, centrifuge it for refinement and to screen out impurities. Then, in a four- to five-hour procedure, they inject the fat into the layers of the breast through six to eight, two-millimeter incisions in each breast. (One millimeter is the width of a single line drawn by a ballpoint pen.) Blunt syringes and cannulas are used to place the fat so that no damage is done to blood vessels or nerves. The fat is layered from the pectoralis major muscle
Pectoralis major muscle
The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...
up through the top of the breast; the surgeons rely on the fat injections to shape the breasts for an aesthetic, natural-looking result.
The American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS) formerly advised surgeon members and the public against fat transfer augmentation procedure because the methods for harvesting fat cells had not been standardized and due to concerns about side effects such as oil cysts, calcification, and tissue scarring. Since then, improvements in mammography equipment and methods for harvesting and injecting fat cells have been refined and reduced the associations' concern. When compared to saline or silicone implants, they currently state that there "is little clinical evidence, pro or con, exists to suggest that fat grafting is safer or better than saline or silicone implants."
The ASPS issued a new policy paper on Fat Transfer/Fat Graft and Fat Injection on March 11, 2009. In it, the Executive Committee approved a policy paper. The paper offers background information on the applications, risks and complications, and techniques of fat transfer procedures. The paper also summarizes scientific evidence. Additionally, four guiding principles are stated, based on the conclusion that fat grafting is a safe procedure in select cases; and that results are dependent on a surgeon's technique and expertise. Indications for fat grafting included: Micromastia
Micromastia
Micromastia, or breast hypoplasia, is a medical term describing the postpubertal underdevelopment of a woman's breast tissue. Just as it is impossible to define 'normal' breast size, there is no objective definition of micromastia. Breast development is commonly asymmetric and one or both breasts...
; post-breast augmentation
Breast augmentation
Breast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...
deformity, with or without removal of implant; Tuberous breasts
Tuberous breast deformity
Tuberous breasts are a result of a congenital breast deformity or abnormality which can occur in both men and women . During puberty breast development is stymied and the breasts fail to develop normally and fully. The exact cause of this is as yet unclear...
; Poland's Syndrome, post-lumpectomy
Lumpectomy
Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...
deformity; post-mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
deformity; deficits caused by conservative treatment or reconstruction with implants
Implant (medicine)
An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. Medical implants are man-made devices, in contrast to a transplant, which is a transplanted biomedical tissue...
and/or flaps (latissimus dorsi or TRAM); damaged tissue resulting from radiotherapy and nipple reconstruction. There is at least one registered clinical trial, ID:NCT00466765, currently with open enrollment.
In addition to these referenced reconstructive procedures, fat transfer was introduced for use in the high risk breast cancer patient. The patient undergoes standard bilateral nipple sparing mastectomy and liposuction. The lipo-aspirate is stored using known biological tissue storing techniques in liquid nitrogen. After a suitable healing period, the lipo-aspirate is injected in serial treatments to build to a natural contour. Given a relatively small breasted woman with sufficient donor fat, the breasts may be enhanced in size over the preoperative state.
Results
Because the surgeon usually must inject too much fat to allow for reabsorption, the overcorrection can make the patient’s face look too plump or swollen for about a week. However, many patients are able to return to their normal activities immediately. Most notice some bruising, swelling, and redness in the donor and injection sites. Results from patients, physicians, and other researchers place the durability of fat injections anywhere from half a year up to eight years.Potential risks and side effects
"Firmness and Lumpiness- While most transferred fat results in a natural feel, it is possible thatsome or all of the fat may become firm, hard, or lumpy. If some of the fat does not survive the transfer, it may result in fat necrosis (death of transferred fat tissue), causing firmess and discomfort or pain. Cysts may also form at the site of the transferred fat. Surgery may be required to improve such conditions." source: Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force Karol A. Gutowski, MD, Chair, and the ASPS Fat Graft Task Force. figure 1: INFORMED CONSENT FOR FAT TRANSFER PROCEDURES (FAT GRAFTS AND FAT INJECTIONS)
Fat transfer remains controversial although many plastic, dermatology and cosmetic surgeons offer various fat transfer procedures to their patients because the procedure is so well received by patients.
Potential risks of any fat transfer include bleeding or hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
, (a pool of blood forming under the skin), infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, nerve damage or wound dehiscence, when a surgical wound opens. Sometimes, fluid collection, or seroma
Seroma
A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid....
, around a surgical wound happens. While all are normally easily controlled and healed, more serious complications can arise. In the case of the former Miss Argentina, Solange Magnano
Solange Magnano
-Life:Magnano was born in Córdoba, Argentina. She won the Miss Argentina crown in 1994 and later created her own modeling agency.-Death:On November 29, 2009, she died of a pulmonary embolism due to complications following a cosmetic gluteoplasty she had undergone in Buenos Aires.-External links:*...
, the gluteoplasty led to pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
, which she succumbed to on November 29, 2009 after three days in critical condition. A close friend, Roberto Piazza, was quoted as saying the liquid from the injections "went to her lungs and brain."
Overall, the survival of injected fat seems to depend on how the physician harvests the donor fat, the technique used to treat the fat and how the prepared fat cells are put back into the patient and the site to which the fat was moved. Doctors Summer and Sattler found that fat survives equally well when removed with suction via liposuction
Liposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
or when withdrawn by a syringe. The issue of survivability seems most affected by where in the body the fat is transferred, how much that site moves, how muscular it is and if disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
is present.
When a large area like the buttocks is treated, the patient may have to stop normal activities for a while and can expect some swelling, bruising or redness.