Primary Breast Augmentation Using Autologous Fat Grafting

There are group of patients that do not want implants. these patients want to have a more natural look and feel. These patients tend to be older, have been pregnant, have lost upper fullness, and most of them want only minimal size change. Fat grafting can provide size and natural feel without the use of breast implants. For significant size changes, more than one session will be needed. The most important point that fat transfer to breast is emphasis on “Quality rather than Quantity” like greatest enhancement at the cleavage; the area not often enhanced by submuscular implants. 

Therefore, today in cosmetic surgery, it is possible to achieve an increase in breast volume by tinny scars technique & without using synthetic material, this technique is particularly indicated in patients:

  1. Who refuses prostheses.
  2. Aim at a natural result over time in patients with a modest breast volume.
  3. Do not want an excessive increase in the breast volume. If they want, they have to understand that more than one session will be needed.

Candidates for this surgery are also those who have been pregnant and have breast-fed their children. In these patients, the breast is undoubtedly emptier in the superior quadrants and droopier for that, they are looking to full and enlarge only the upper portion of their breast.

The patients for breast enlargement by fat transfer must have:

  • Realistic expectations before surgery; patient needs to know that one session of fat transfer to breast is to full her bra. It is uncommon to shift the brassiere to size larger  in one session. So, the consultation is very helpful when it assisted with 3D imaging and using software like Vectra machine to give them the expected outcome from the surgery.
  • Unwanted fat located in the areas of the body that can provide enough fat to ensure an increase in volume by at least one cup bra size.

This surgery besides providing tissue to increase breast volume, fat harvesting also promotes, by lipoaspiration, an improvement in body profile and contour. This surgery represents 2 in 1 (Breast Reshaping plus Body Contouring)

Breast Augmentation by fat transfer is not recommended in:

  1. Extremely slender patients.
  2. Patients with moderate to severe glandular or skin ptosis are not indicated to lipofilling of breast without combining it with breast lift surgery.
  3. Patients who have possible familiarity for breast carcinoma.

Fat Transfer Enriched with Stem Cells
as (SVF or Cultured ADSCs) to
Optimize the Outcomes

Adding Adipose-derived Stem Cells (ADSCs) to transplanted fat whether as expanded & cultured stem cells or as SVF (Stromal Vascular Fraction) has led to a novel technique of fat grafting specially for primary breast augmentation which was termed Cell-Assisted Lipotransfer (CAL).  Recently, the studies have demonstrated that the number of ADSCs in aspirated fat tissue is less than that in excised fat because most of the stromal tissue, in which some of the stromal cells including stem cells (ADSCs) exist, in the subcutaneous fat remains in the donor site. therefore , CAL is thought to be effective  by normalizing the number of ADSCs in the aspirated fat by increasing the number of ADSCs in the aspirated fat by adding on-site prepared SVF or previously prepared cultured expanded stem cells. thereby, converting relatively ADSCs-poor aspirated fat to ADSCs-rich fat

Benefits of Stem Cells in a Fat Transfer

  1. Grow new blood vessels to nourish the fat.
  2. Release anti-inflammatory agents to aid healing.
  3. Generate and release growth factors that support graft survival
  4. Improve skin tightening and rejuvenation.
  5. No risk of allergic or adverse reaction.
  6. The therapeutic target is converting relatively ADSCs-poor aspirated fat to ADSCs-rich fat.

Complications of Breast Augmentation by Fat Transfer

With this surgery the patient will be free from concerns associated with foreign materials and related complications and potential implant replacement or removal.

Problems related to beast lipofilling derived from fat necrosis can be seen appear as cyst formation and calcification. Small cysts (<8 mm) can be detected by ultrasonic examination and usually disappear between 6-18 months, so no treatment is needed. small calcification may occur 1-2 years after surgery but they are usually easy to distinguish from malignant signs and mount of it could be less than calcification than can occur with other breast surgeries like breast reduction. A large volume of fat injection in small recipient breast can cause more fat necrosis. 

References:

  1. Alberto Di Giuseppe, Dennis Wolf. Breast Augmentation with Stem Cells Fat Trasnfer and VaserTM. In: Melvin A.Shiffman, Alberto Di Giuseppe, Franco Bassetto, editors, Stem Cells in Aesthetic Procedure: Art, Science, and Clinical Techniques. Springer-Verlag Berlin Heidelberg; 2014. P 529-56. 
  2. Bircoll, M. Cosmetic breast augmentation utilizing autologous fat and liposuction techniques. Plast. Reconstr. Surg. 79: 267, 1987. Click Here for PDF
  3. Bircoll, M., and Novack, B. H. Autologous fat transplantation employing liposuction techniques. Ann. Plast. Surg. 18: 327, 1987. Click Here for PDF
  4. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg. 2007:119(3);775-85 Click Here for PDF
  5. Delay E. Lipomodeling of the reconstructed breast. In: Spear S, editor, Surgery of the breast: principles and art. Philadelphia: Lippincon Williams and Wilkins; 2006. P 930-46. 
  6. Delay E. Breast deformities, In: Coleman SR, mozzola RF, editors, Fat injection: from filling to regeneration. St Louis: Quality Medical Publishing; 2009, p.545-86 
  7. Delay E, Garson S, Tousson G, Sinna R. Fat injection to the breast: technique, result, and indications based on 880 procedure over 10 years. Aesthet Surg J, 2009, 29(5):360-76 Click Here for PDF
  8. Fournier, P. F. The breast fill. In Liposculpture: The Syringe Technique. Paris: Arnette-Blackwell, 1991. Pp. 357–367. 
  9. Holle, J. Lipofilling in rhinoplasty and breast augmentation. Presented at the American Alpine Workshop in Plastic Surgery 17th Annual Meeting, Sun Valley, Idaho, February 12– 17, 2006. 
  10. Isaacs, G., Rozner, L., and Tudball, C. Breast lumps after reduction mammaplasty. Ann. Plast. Surg. 15: 394, 1985. Click Here for PDF
  11. Khouri RK, Schlenz I, Murphy BJ, Baker TJ. Nonsurgical breast enlargement using an external soft-tissue expansion system. Plast Reconstr Surg. 2000;105:2500-2512. Click Here for PDF 
  12. Kølle SF, Fischer-Nielsen A, Mathiasen AB, Elberg JJ, Oliveri RS, Glovinski PV, Kastrup J, Kirchhoff M, Rasmussen BS, Talman ML, Thomsen C, Dickmeiss E, Drzewiecki KT. Enrichment of augtologous fat graft with ex-vivo expanded adipose tissue-derived stem cells for graft survival: a randomised placebo-controlled trial. Lancet. 2013 Sep doi: 10.1016/S0140-6736(13)61410-5. PubMed PMID: 24075051 
  13. Veber M, Tourasse C, Toussoun G, Moutran M, Mojallal A, Delay E. Radiological findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg. 2011;127:1289-1299. Click Here for PDF
  14. Yoshimura K, Aoi N, Eto H, Doi K, Hato H. Minimal Scar Breast Augmentation using Autologous Fat Grafting. In: Rubin J, Jewell ML, Richter DF, Uebel CO, editors, Body Contouring and Liposuction-E-book. Elsevier Saunders; 2013, p.644-56. Click Here for PDF
  15. Yoshimura, K., Matsumoto, D., and Gonda, K. A clinical trial of soft tissue augmentation by lipoinjection with adiposederived stromal cells (ASCS). Presented at the International Fat Applied Technology Society Third Annual Meeting, Charlottesville, Virginia, September 11–14, 2005. Click Here for PDF

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