The Efficacy and Safety of Fat Transplantation to the Breast for Augmentation Mammoplasty

Sunday, April 14, 2013: 10:17 AM
Scott L. Spear, MD, FACS, Troy Pittman, MD, Ali Al-Attar, MD, PhD and Steven J. Rottman, MD, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC

The current standard for breast augmentation involves placement of an implant.  Although implants are generally safe, they are foreign bodies with inherent risks including capsular contracture, infection, device failure, malposition, etc.  In order to avoid an implant, surgeons and patients have been exploring breast augmentation using autologous tissue in the form of injectable fat.  Early reports of autologous fat transplantation to the breast have been mixed, with increases in breast volume which have been generally modest.  On the safety side,  there are concerns regarding complications as well as  interference with cancer detection by mammography or MRI. 


With a grant from the Aesthetic Surgery Education and Research Foundation (ASERF) , we  prospectively studied 10 consecutive patients undergoing augmentation mammoplasty using autologous fat transfer.  Autologous fat was harvested (typically the abdomen or thighs) using standard low pressure machine liposuction and a 3mm cannula.  Fat was then infiltrated into multiple planes including subcutaneous, subglandular, and intramuscular  using blunt cannulas.  Preoperative direct measurement, 2D and 3D images, mammograms and MRIs were obtained as  baseline controls.  Effectiveness was evaluated by attempting to compare fat volume retention 1-year postoperatively using 3D imaging,  standard breast MRI volume measurements, pre and post-operative direct physical measurements  (e.g.  N-IMF, SN-N, BW,  and breast circumference) and subjective aesthetic comparisons based on 2-dimensional images graded  by blinded observers and scored on increase in breast size. Overall patient satisfaction was assessed using an abbreviated version of the breast Q.


Results to be presented will include volume retention of fat at 1-year using : 1. Changes in standard measurements of breast width and circumference, 2. Volume changes estimated  by comparing pre and post-operative 3D images and breast MRI, 3. Subjective comparisons based on 2-dimensional images graded  by blinded observers and scored on increases in breast size.  Also, post-operative mammographic and MRI findings including pre and post fat grafting BIRADS scores will be presented .


This study was intended to be a pilot baseline study to establish the safety and efficacy of Autologous Fat Grafting to the breast. The limitations, of the study as well as its findings will be presented and should help provide insight and direction for future research.