Making Breast More Beautiful with Fat

Goals/Purpose: Fat grafting to the breast for aesthetic indications has become increasingly popular. Numerous techniques of fat grafting have been used to simplify, standardize, and improve the procedure. In 2006 the senior author (SRC) began using autogenous fat grafting in patients seeking aesthetic enhancement of their breast. Herein, we describe our evolution and preferred techniques, the best clinical indications for using fat alone or in combination with implants and other procedures, and our clinical results and complications.

Methods/Technique: We retrospectively studied 168 patients, all-female with an average age of 45 years (range of 17-78). In addition to demographic parameters, the type of procedure, the amount of fat transferred, the site(s) of fat harvest, operative times, and the patient’s postoperative recovery and outcomes were recorded.

Results/Complications: Of the 168 patients 105 had natural augmentation. Of these 105 patients, 14 (8%) also had implant removal w/ and w/o capsulectomy and 10 (9%) had mastopexies. Composite augmentation was performed in the remaining 60 patients to address chest wall abnormalities, poor soft tissue coverage, regional variations in breast shape and/or asymmetry. The average amount of fat used was about 208 cc per breast. Forty-five patients (26.7%) underwent a second procedure, most related to complex congenital deformities, implant failures and rarely for requests for additional fat grafting. Few patients underwent secondary surgery for enhancement. Of the 168 patients 37 (22%) had adverse events unrelated to the fat graft such as suture abscesses, scarring and minor skin breakdown at the incision junctions in mastopexy patients. Only one patient (0.6%) developed a 'lump’ between the breast thought to be secondary to the fat transfer. Abnormal mammograms were reported in 2 patients, one of whom developed recurrent breast cancer and the other for a suspicious mass that was biopsy negative. In addition, one patient underwent simple aspiration of a lipid cyst.

Conclusion: Autologous fat grafting should be considered in all patients having primary and secondary aesthetic breast surgery. Complications related to fat grafting are extremely rare. As in all aesthetic procedures, revisional and secondary surgeries may be needed to achieve the desired outcome. Auto-infusion of fat using a closed system has become our preferred technique.