Controversial Fat Injections Can Improve Breast Reconstruction; Jury's Out On Augmentation

"My reconstruction patients could not be happier with the improvement fat transfer gives to the appearance of their breasts," said Gregory Scott, MD, ASPS Member Surgeon and study co-author. "The initial implant reconstruction sometimes leaves them with contour deformities or wrinkling, but fat injections can correct these problems and give their breasts a smoother, softer, more natural appearance."

The study looked at 21 patients who had 42 fat transfers for contour deformities or wrinkling. The injections were performed an average of 9.9 months following reconstruction. The fat was taken from the patients' abdomen or upper thighs. The study found that fat injection to the breast for reconstruction is safe, improves breast shape, and corrects implant wrinkling.

While fat injection in breast reconstruction is more accepted because there is no breast tissue left after mastectomy, cosmetic use of fat injections to the breast remains controversial. At Plastic Surgery 2008, a panel entitled, "Should We Inject Fat into the Breast," will discuss and analyze the medical and legal risks, patient safety implications, as well as potential benefits of cosmetic fat injections to the breast.

"At this point, there are no good scientific studies about cosmetic use of fat in the breast - this is an evolving issue without any scientific data," said William P. Adams, Jr., member of the ASPS Emerging Trends Committee and panel presenter. "We need to have good, sound, scientific studies to determine the usefulness and safety of this methodology before we offer it to our patients."

Two reasons noted for the controversy: one, fat can "calcify" in the breast and obscure mammograms or possibly be mistaken for fibrous cancer growths. Two, it is unknown how much fat is needed to adequately enlarge a breast, if and how much of the injected fat will be absorbed by the body, or how much time the procedure will take.

"Based on current reports these procedures are taking multiple hours in the operating room and yielding minimal enlargement, you really need to wonder how useful and safe that is for the patient," said Dr. Adams. "Nevertheless, this is all still unknown. For that reason, we need to wait until the issue has been studied in a controlled, scientific environment."

Another panel presented at Plastic Surgery 2008, "The Science of Fat Transfer – The Skinny on Fat," will examine fat transfer for a variety of purposes including breast surgery, wrinkle reduction, lip augmentation, and to restore damaged tissue resulting from injury or illness. How to harvest and process fat; the biology of fat-derived stem cells; pharmacologic factors that can increase fat's survival and lessen the absorption rate; and the use of fat transfer to treat tissue damaged by radiation therapy will be explored.

Nearly 348,000 breast augmentations were performed in 2007, making it the number one cosmetic plastic surgery procedure last year, according to ASPS statistics. There were more than 57,000 breast reconstruction procedures performed in 2007.