One of the most talked about topics at the most recent Plastic Surgery Society National Meeting was fat grafting to the breast. Historically, this was not done secondary to breast cancer concerns. What if the additional fat increased risk for breast cancer? What if some of the fat became hard and was difficult to discern from a cancerous mass?
Pioneers in this and other countries performed studies, and there appears, to my knowledge, to be no cancer risk associated with fat grafting. As for the masses, it turns out that most look very different on radiologic studies than cancer and are therefore not now considered as concerning.
Many surgeons use fat grafting as an adjunct to breast reconstruction. This is most frequently done to feather the hard edges of an implant or tissue flap. See the case of the month below. It takes several sessions to get the desired effect, but many of my patients and I have been happy with the results. It is not a procedure for everyone and results do vary. One new concept is to place a relatively small back or abdominal piece of tissue in the breast mound position with the intent to go back later and inject fat into the improved tissue bed. Another is to use the fat to improve the condition of radiated tissue.
Other surgeons are starting to use fat grafting for breast augmentation instead of implants. There are many problems with this approach, but I have seem some nice results presented. One problem is that many woman who are small enough to need implants do not have enough extra fat for grafting. Some may have enough fat for only a small size increase compared to an implant. Another problem is that larger amounts of fat may have more difficulty surviving and may be associated with more complications. Finally, the procedure takes a long time and may be cost prohibitive. These techniques are still new, so implants are how I plan to do breast augmentation. I will keep learning the new techniques and only offer them to my patients when they present a good risk benefit balance.
