Women that desire a modest increase in breast size are generally the best candidates for breast fat grafting. The breasts should start with a nice shape and have good skin tone. Patients that have poor skin, sagging breasts, or desire a large increase in breast size are not good candidates for breast augmentation with fat transfer.
Breast shape, especially the cleavage and upper part of the breasts, is enhanced. The breast size is typically increased by about three-quarter to one full bra cup size. Patients considering breast fat grafting must be realistic about their expectations. For those desiring large, round, augmented-appearing breasts a breast augmentation with implants will be required.
Breast Implants Plus Fat Grafting
In complex cases fat grafting can be used during a breast implant procedure to optimize the breast shape. In some cases the breasts can be very misshapen and implants alone cannot create normal breasts. The residual irregularities of the breasts can be filled in with fat grafting to achieve an aesthetic shape. Dr. Connall had found that the addition of fat grafting to complex breast augmentation cases has led to superior results that could not have been achieved with implants alone.
Breast Lift Plus Fat Grafting
One of the chief goals of a breast lift is to create more fullness in the upper portion and cleavage of the breasts. This is difficult to accomplish with a breast lift alone. Hence, the most common solution is to include a breast implant, with the breast lift, to provide more volume in the upper breast. This can result in the use of overly large breast implants that can put excessive stress on the breast tissues and skin.
We have found that adding fat to the cleavage and upper breast is an ideal way to sculpt those areas during a breast lift. Whereas an implant puts undue stress on the tissues (sometimes causing recurrent sagging of the breasts), fat grafting is gentle on the breasts. Dr. Connall has seen superior results in breast lift patients that also have fat grafting.
Fat Grafting For Implant Problems
Uneven breast shape, asymmetry in shape and volume, and visible implants ripples are a few of the unfavorable conditions associated with augmented breasts that can be helped with breast fat grafting. Dr. Connall has treated many types of implant problems by leaving the implants in place and adding fat to select areas around the implants.
Breast Reconstruction With Fat Grafting.
Breast defects following lumpectomy for breast cancer can be filled with fat grafting, leading to normal breast shape. Dr. Connall has successfully performed this procedure.
Total breast reconstruction following mastectomy can be performed with fat grafting. Fat grafting after mastectomy is a revolutionary procedure and spares the patient from the traditional methods of reconstruction which require implants or complex tissue flaps. Total reconstruction is a multi-stage process in which 2-4 sequential breast fat grafting operations are required.
Dr. Connall was the first surgeon in Oregon to perform complete bilateral breast reconstruction with fat grafting only (following nipple-sparing mastectomy) in 2012.
Breast Preparation And The BRAVA
To achieve reliable results from breast fat grafting the technical aspects of the procedure must be optimized. To optimize the survival of the grafted fat, we request that most patients wear the BRAVA before and after surgery.
The BRAVA is an external breast expander that thickens the tissues and stretches the skin. The thickened breast tissues accept greater volumes of grafted fat, thereby allowing a larger augmentation with a single fat grafting procedure. Also, the BRAVA increases the blood flow and oxygenation of the breasts (including after the fat grafting procedure) which may enhance the survival of the grafted fat. Therefore, in most cases we have patients wear the BRAVA after surgery.
The BRAVA must be worn several hours per day for weeks before surgery to confer a benefit. The BRAVA is cumbersome, but manageable for most patients. Though wearing the BRAVA is bothersome, most women gladly accept the trade-off to get the best results and a life-long improvement in their breasts.
BRAVA domes are covered with the supportive bra.
A Rapidly Growing Procedure
Breast fat grafting is an emerging procedure in plastic surgery. The procedure and its applications are growing rapidly around the world and in the United States. Dr. Connall is at the forefront of this revolutionary technique.
With new procedures, new risks and concerns must be evaluated and discussed openly with patients. Like any surgical procedure, breast fat grafting has risks and adverse events can occur.
A key issue for surgeons and patients is the possible impact of injected fat on the feel of the breasts and the appearance of the breasts on mammogram, ultrasound, and MRI. Breast lumps, cysts, and calcifications can occur after breast fat grafting, just as they can after other breast procedures. The developing consensus is that grafted fat looks distinct on breast imaging and is generally distinguishable from lesions suspicious for breast cancer.
In our experience the most common adverse event is the creation of fatty cysts within the breasts. These cysts can sometimes be felt and on rare occasion can be painful. Most cysts can be aspirated with a needle during a simple office procedure and improvement and sometimes resolution can occur.
The most common unsatisfactory outcome is insufficient “take” of the fat. That is, simply not enough fat survives to create a desirable volume and/or shape of the breast. We are very open with patients about the unpredictability of fat grafting and emphasize that only mild to moderate changes in the breasts should be expected from any one treatment. With multiple treatments, larger volumes and more dramatic results can be achieved.
Breast Cancer Risk
The other key issue is theoretical concern about the effect of transferred fat on breast cancer development. Simply put: can grafted fat cause breast cancer? Since fat contains hormones, growth factors, and multiple cell types (such as stem-cells) this is an important question for surgeons, scientists, and patients to consider.
Presently, there are no data in humans showing that fat injected into the breast causes breast cancer. Thousands of breast fat grafting cases have been performed world-wide, many in breast cancer patients, and an increase in breast cancer rates has not occurred. In addition, surgeons have been transferring blocks of fat to breasts for breast reconstruction for three decades and increases in breast cancer have not occurred.
However, it will take many years and experience with thousands of patients before the scientific community can determine with certainty that breast fat grafting will not contribute to breast tumor growth.
Breast Health Follow-Up Is Critical
Patients considering breast fat grafting must understand and accept the risks and be diligent in following their breasts with routine breast exams and imaging studies. We require all breast fat grafting patients to obtain a mammogram before surgery and 9-12 months after surgery. If irregularities from the fat are seen on the post-op mammogram then those are documented, providing a "map' that radiologists can reference for comparison with all future mammograms.
Fat Grafting And Your Consultation
If you desire breast augmentation (or other breast procedure) with your own fat, then your consultation with Dr. Connall will be directed to that approach. Dr. Connall’s experience with major breast fat grafting is one of the greatest in the U.S. He will give you an honest and realistic appraisal of the role of fat grafting for your specific anatomy and goals. Even if breast implants are your first choice, Dr. Connall will inform you about this exciting option if you are a suitable candidate.