I recently read an article that dealt with the use of autologous fat to enhance breast shape and size. What was unusual is that this article appeared in the “Journal of Dermatologic Surgery”. I thought that was unusual and interesting. It seems specialties are expanding their reach whether justified or not.
This article was basically a review of the world literature and I found it very informative. The first autologous fat transferwas credited to a Dr. Neuber in 1893 when he used fat to fill in depressed acne scars. It would be interesting to see what his method of harvesting was. The first reported case of using autologous fat for breast augmentation was done in 1895 by a Dr. Dzerny. Just when you thought you had something unique and special. A survey done by plastic surgeons in 2010 revealed that 73% of plastic surgeons use autologous fat in their breast reconstruction. I do and I think it is a great technique we can use to create a more shapely reconstructed breast.
The greatest area of controversy surrounds the preparation of the fat. I harvest my fat with a tumescent technique. I will usually add PRP (platelet rich plasma) to the fat prior to injection. I do NOT centrifuge my fat because I feel that the less we handle the fat the more fat cells survive. There is no one BEST way to obtain and prepare the fat for eventual grafting. When I graft the fat I create multiple small tunnels to inject the fat. This maximized the taking of the fat. Usually I tell my patients 50-70% of the fat will take. There is no increased risk of malignancy associated with fat grafts and mammograms are still a reliable screening device. I think one of the limitations of a woman who wants to go with autologous fat versus an implant is that she must have a generous amount of extra fat. Woman always think they have more than they really do. I tell them I can’t go and buy some fat at Home Depot. In some cases I’ll do what I call a composite aug which is an implant overlayed with fat. This is the frosting on the cake. This is a great procedure and truly enhances our ability to create a more attractive breast post op.