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breast enlargement

Breast augmentation can now be performed by taking unwanted fat from one area of your body and transferring it to your breasts. But is this “two-for-one,” natural enhancement procedure too good to be true?

For the second year running breast augmentation is the nation’s most popular cosmetic procedure, with 290,467 patients choosing to have their breasts enhanced through surgery last year, according to recent statistics from the American Society of Plastic Surgeons (ASPS).

The same statistics also show an increase in the popularity of fat grafting, a procedure in which fat is taken from one area of the body and transferred to another. Breast augmentation via fat transfer increased 72 percent in 2016.

The idea of taking fat from an area where there is too much and using it to increase the size of the bust is obviously an enticing prospect to many women. But is this “two-for-one,” natural enhancement procedure too good to be true?

breast implants

RELATED: Zwivel’s Complete Guide to Breast Augmentation

How Natural Breast Augmentation Is Performed

Fat transfer breast augmentation, technically referred to as augmentation mammoplasty using autologous fat transfer, uses liposuction to remove fat from one part of your body — typically the tummy, thighs, or flanks (love handles) — and inject it into your breasts.

Here’s how it works. First, the plastic surgeon selects a donor site. The fat is then extracted using a special liposuction method that prevents destruction of the living fat cells. After processing the suctioned fat and fluid into pure fat, the surgeon carefully injects hundreds of minute individual fat droplets into the breast site using an instrument called a cannula.

This method is used to prevent the small vessels near the tissue from bleeding, in turn preventing the transferred fat cells from dying. Through this process the fat is naturally incorporated into the breasts’ matrix of adipose (fat) tissue, resulting in larger breasts.

fat transfer

RELATED: Fat Grafting Turns Liposuction Byproduct Into Liquid Gold

Ideal Candidates

Fat transfer can be a good option for women who prefer natural results as opposed to having an implant placed in their breast. But it’s not suitable for every woman.

“Ideal candidates for fat transfer breast augmentation are patients who desire a modest increase in breast size without a significant need for breast lift, and who have adequate fat in donor sites,” says Ulysses H. Scarpidis, MD, Director of Plastic Surgery at Scarpidis Aesthetics in New York. “Younger patients who do not smoke and have a healthy circulation often times have better, more consistent results.”

A patient’s health and relative weight are also important factors. “I also prefer to work with healthy patients because they simply heal better than patients who are non-compliant with their nutritional intake or who are smokers,” says Gregory A. Buford MD, FACS, a board-certified plastic surgeon and author of two books, “Beauty and the Business” and “Eat, Drink, Heal: The Art and Science of Surgical Nutrition.”

And the quality of the fat is a crucial factor. “The patient who has ‘good fat’ in sufficient quantities to produce a desirable result (size) is an ideal patient,” says New York plastic surgeon Leonard Grossman, MD. He also points out that good candidates understand that more than one procedure may be necessary.

Is Going “Natural” Better Than Implants?

Natural breast augmentation has several potential advantages. One is the fact that it doesn’t involve any artificial materials. If you like the idea of using your own fat from your abdomen or other area rather than a silicone implant, natural breast augmentation may be right for you. It is also considered to have a more natural feel than the silicone and saline solution with which breast implants are filled.

Furthermore, using your own fat to augment your breast eliminates some of the potential complications of breast implants, says Scarpidis. These include capsular contracture (the formation of a capsule around the breast implant that is sometimes visible and painful), rippling, implant infection, and implant puncture or failure, among others. In addition, says Scarpidis, “fat cells are living cells that produce many proteins that improve skin texture, skin pliability, and overall skin health.”

In recent years major strides have been made to minimize scarring from breast augmentation, such as placing the incisions in discreet locations. But with natural breast augmentation you don’t have to worry about this because any scarring is virtually invisible to the untrained eye, according to Grossman. He also points out that patients don’t have to worry about implant breakage or replacing an implant.

And, while today’s implants come in many shapes and sizes, augmentation via fat transfer offers more flexibility; the amount and location of the fat is tailored to the individual patient’s wants and needs.

Last but not least is the fact that the procedure allows patients to eliminate fat from areas of the body where it is unwanted.

liposuction

RELATED: Zwivel’s Complete Guide to Liposuction

Can Fat Transfer Be Combined with Implants?

In a word, yes. Most plastic surgeons believe that combining fat transfer with breast implants is a good option in some cases. In these cases the implant is typically placed below the muscle (subpectoral placement).

Why would you want to combine the two? “When used in combination with a breast implant, the fat often acts as a contouring agent to help better control the overall shape and contour of the breast and can effectively fill in gaps and volume where the implant has not,” Buford explains.

Many plastic surgeons consider this an ideal option for thin patients that need some areas filled in, such as the upper pole (the area of the breast above the implant). “The implant allows larger volumes and the fat allows smoother contours in patients with thinner subcutanous (fat) tissue,” says Gregory M. Fedele, MD, FACS, a board-certified plastic surgeon practicing in Beachwood, OH. Adding fat can also make the implant appear more natural or be used to influence the shape of the breast, if necessary.

Fat transfer can also be used after the fact — that is, for patients that have already undergone breast augmentation with implants — according to Gurmander Singh Kohli, MD, FACS, a board-certified plastic surgeon in Melrose, MA. Examples include patients that were left with asymmetries after the initial procedure, those whose tissues have thinned out with aging, and those with implant imperfections that have become visible. “[Addressing these concerns with fat grafting] is a much simpler procedure and gives very predictable results,” says Kohli.

However, some surgeons don’t believe that combining fat transfer with breast implants is a good first option. “If a patient is interested in implant augmentation, almost any size can be achieved with implants alone,” says Scarpidis. Once a patient has undergone implant based surgery, fat transfer remains a good option for improving asymmetries as well as specific areas of the breast such as the cleavage, and for further enhancement of the breasts at a future date.

Too Good to Be True?

Not really, but there a many things a potential patient must consider before choosing to “go natural.” For example, among plastic surgeons there are differing opinions with regard to the reliability of fat transfer and the predictability of the technique’s results. “Approximately 50-65% of the fat graft will be permanent, but this can vary and there can be unequal reabsorption of the fat leaving asymmetry that may require revision fat grafting,” says Fedele.

This is due in large part to the fact that fat injections to the breasts involve the transfer of living fat cells. When these cells are transferred to the breasts, blood supply must be reestablished in order for them to survive. “Too many fat cells transferred overcrowd the blood vessels, resulting in some fat cells not receiving adequate access to the blood vessels. In such cases they are reabsorbed by the body, as they lack the necessary vitamins, nutrients, and oxygen to survive,” says Scarpidis.

“Furthermore, differences in the number of blood cells between the right and left breasts can result in different survival rates of fat cells transferred,” he adds. “These can affect the results and symmetry.”

Results of fat transfer to the breasts depend largely on the viability of each patient’s fat cells. It is also important to understand that fat cells transferred to the breasts will continue to act like fat cells – weight gain will cause them to enlarge, and weight loss will make them diminish.

Other factors that affect fat cell viability in fat transfer surgery, according to Scarpidis:

  • Harvesting technique
  • Injection technique
  • Volume injected
  • Patient anatomy
  • Patient healing capacity
  • Asymmetries between a patient’s breasts

He also notes that the aging process doesn’t stop; the shape of the breasts continues to change, they will droop, and you may need additional procedures in the future.

Results of implant-based breast augmentation are more predictable since inanimate, equal objects are placed in the patient’s breasts without the risk of reabsorption or the reliance of blood vessel anatomy.

Grossman adds that breast enhancement with fat grafting also tends to be more expensive. And a single procedure may not be able to produce significant augmentation. He also points out that the right fat must be used in order for the procedure to produce permanent results; the fat used for the transfer should not respond to diet or exercise.

Grossman also believes that any “non-take” of fat — i.e., some of the fat dying off and being absorbed by the body — only happens with improper technique and use of the wrong kind of fat. “If one follows the simple rules of fat grafting, then the loss of fat is very symmetrical… the knowledge and skill of the surgeon is of paramount importance,” he says.

This is true of any surgical procedure. Once you have established that you are a suitable candidate, the experience and skill of your surgeon are what counts.

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