Recently, I have been reading articles from the New York Times and my own journals that advocate considering the usage of autologous fat (harvested from your own body) for the purpose of enhancing the breasts.  On first glance, which option sounds better, your own fat or an implant made of a foreign material?  I vote for the implants for various reasons.  Some are practical, some financial and some just make sense medically to me.

Reason #1:  Most of the breast implants that I insert are between 350 to 450 cc.  To harvest the amount of fat needed to perform this procedure would mandate harvesting at least 1.5 liters of fat in order to perform the procedure.  The process of obtaining the fat, via a small cannula, purifying it and reinjecting it in very small amounts is very time intensive. A certain amount of fat cells will be damaged, thus they would reabsorb into the body within the first year.  I have performed fat transfer in other areas of the body for many years but I foresee the difference in technique amongst unpracticed surgeons will make the long term results unreliable at best.

There was an interesting french study that looked at 880 procedures for reconstructive procedures over 10 years. Preoperative breast screening was done with mammogram, ultrasound and MRI.  The same studies were repeated 1 year after the procedure.  The findings were that 40% of the fat was reabsorbed.  Approximately 15% of the patients developed lumpy scar tissue. Most patients had changes in their mammograms but the radiologists were able to interpret them correctly although some biopsies were still performed.  Even with the fat loss and breast changes, 90% of patients rated their results as "good" or "very good".

Reason #2:  Recent debates regarding mammography demonstrate that the mammogram is the first line of defense in detecting breast cancer.  While some surgeons feel that mammography is not affected, I do.  The possibility for fat necrosis and cysts are a very real probability. Lumpy deposits of injected fat that have not survived a transfer, can feel exactly like a breast cancer.  Thus, "spots" detected in mammography will be investigated for cancer that otherwise would not have existed.

Reason #3:  The long term results cannot be realistically evaluated for at least a year.  The breast size will be affected by weight gain or loss and different amounts of fat may survive in each breast. 

Reason #4: The cost would be greater than a simple breast augmentation due to the technique and time involved.

 I most often use silicone breast implants for the augmentations I perform.  We have all heard the scary stories that came out many years ago.  The scientific community jumped on the public concerns and did study after study regarding safety.  They all verified that silicone implants were a safe method to use to augment the breast tissue.  After surgery, the body makes a thin capsule to wall off the implant from the rest of the breast.  In about 5% of the patient community some contracture of the breast will occur.  Otherwise, the breast remains the same size as several weeks after the swelling subsides.

The procedure of fat graftng to the breast may become a more viable possibility when guidelines are established for preoperative and postoperative imaging and a technique is agreed upon that produces the best result and fewest complications. For now, I believe that breast implants are the safest and most aesthetically pleasing choice.