Saturday, September 19, 2009

Two for One-- Liposuction and Fat Transfer to the Breasts for Augmentation? An Interview with Dr. Jennifer Walden


Does it sound to good to be true to increase your breast size and slim down your tummy or thighs at the same time? On Wednesday morning, Gretchen Carlson and Steve Doocey on cable TV’s top rated morning news show, Fox and Friends, interviewed me on the newest procedure in breast enhancement by fat transfer from other areas of the body. Possible interference with mammography and breast cancer are discussed as well as the technique used for this method used to enhance the female breast. I am Dr. Jennifer Walden, and serve as the program director of the Dept of Plastic Surgery at Manhattan, Eye, Ear and Throat Hospital, and performs breast augmentation, lift, and reduction surgery in New York.

For years, saline and silicone implants have served as the most effective method for breast augmentation, and many studies and FDA approval declare both saline and silicone implants to be safe. Breast augmentation has been the most commonly performed cosmetic surgical procedure in recent years.

The relatively uncommon fat transfer breast augmentation procedure has women everywhere buzzing about the ‘benefits” of this seemingly more natural breast enhancement option. Present clinical evidence does not conclude that fat grafting is safer or better than saline or silicone implants, but the idea of taking one’s own fat and repositioning it to augment the breasts is rapidly capturing the attention of medicine, consumers, and the media.

Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient’s buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Fat injections of the breasts may offer patients augmentation with a natural look and feel and the benefit of body contouring through liposuction—without the requirement for incisions or implants.

However, long-term safety and efficacy data as well as the effect of the procedure on breast cancer screening using mammography is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include unpredictable or low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring. Another major concern is long-term problems with breast cancer detection due to difficulties in telling the difference on mammograms between calcifications associated with breast cancer and calcifications associated with fat transfer.

This procedure does offer a modest opportunity for enhancement— specifically, about one cup size increase and the degree of enlargement will depend on the amount of spare fat that the patient has. But, numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? And most importantly, what are the cancer implications of this technique? Research projects, funded by the Aesthetic Surgery Education and Research Foundation (ASERF) of the American Society for Aesthetic Plastic Surgery are being conducted to determine the safety and efficacy of breast enhancement with fat.

In the meantime, plastic surgeons will continue to study the intricate details of the procedure for the safety of our patients– namely, the techniques of harvesting, preparation, and placement of the fat tissue, who should receive fat transfer, when it is appropriate, and whether it is safe for the long term. Results of clinical studies this far seem promising—so maybe going up a cup size with the benefit of a little liposuction elsewhere will be common practice at some point. Anyone reading this should be aware that this procedure is very technique dependent and to avoid complications it must to be done correctly by a properly trained, board-certified plastic surgeon. Methods for tissue harvest and tissue injection have been refined, as fat cells are carefully removed by a specialized liposuction procedure using numerous syringes and transferred to the breast via dozens of minutely small injections. This technique results in increased survival of the fat cells.

Autologous fat grafting is currently used for touching up reconstructed breasts which it is safe and effective for given that the breast tissue has already been removed and these patients are getting routine surveillance imaging. The procedure can also soften the appearance of existing implants and hide visible rippling which is particularly apparent in very thin women with a bony chest wall and little skin or fat with which to work. The amount of fat injected with these procedures is usually a lot less than that used in breast augmentation as well. So, the take home message here is the more long-term clinical trials involving multiple centers as well as radiologist and oncologists need to be done before a blanket endorsement of the procedure can be made. It also serves to mention that this would not be the method of choice for breast augmentation in women who have had or have a family history of breast cancer.

1 comment:

  1. I love watching your videos, you're just so knowledgeable!

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