Summary

Today, fat grafting has gained an essential role in the plastic surgeon’s armamentarium as a safe and easy-to-use tool for an experienced surgeon. Fat grafting has the advantage of using autologous tissue that allows natural reshaping and volume augmentation and the double benefit of removing unwanted fatty deposits in donor sites by liposuction. The technique of autologous fat-graft injection to the breast is applied for the correction of breast asymmetry; of breast deformities; congenital defect correction” micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.

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The technique of autologous fat-graft injection to the breast is applied for the correction of breast asymmetry; of breast deformities; congenital disability correction” micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.

How Is Breast Fat Injections Done?

The technique for injecting fat grafts for breast augmentation allows Prof. Moawad great control in sculpting the breasts to the required contour, especially in the correction of tuberous breast deformity. In which case, no fat graft is emplaced beneath the nipple-areola complex (NAC), and the skin envelope of the breast is selectively expanded (contoured) with subcutaneously emplaced body-fat, immediately beneath the skin. Such controlled contouring selectively increased the proportional volume of the breast concerning the size of the nipple-areola complex and thus created a breast of natural form and appearance; higher likelihood than is achieved solely with breast implants. It may enhance the successful outcome of fat-graft breast augmentation by achieving a pre-expanded recipient site to create the breast-tissue matrix that will receive grafts of autologous adipocyte fat. The recipient site is expanded with an external vacuum tissue expander applied upon each breast. The biological effect of negative pressure (vacuum) expansion upon soft tissues derives from the ability of soft tissues to grow when subjected to controlled, distractive, mechanical forces. Because external vacuum expansion of the recipient-site tissues permits injecting large-volume fat grafts (+300cc) to correct defects and enhance the breast

The fat-corrected breast-implant deformities were inadequate soft-tissue coverage of the implant(s) and capsular contracture, achieved with subcutaneous fat grafts that hid the implant-device edges and wrinkles and decreased the palpability of the underlying breast implant. Fat Transfer or Fat Injections Furthermore, grafting autologous fat around the breast implant can soften the breast capsule. Recently at MSI, fat grafting has been combined with platelet-rich plasma (RP) to enhance the survival of adipocytes inside the breast tissue.

How Is Post-mastectomy Reconstruction with Fat injections Done?

The reconstruction of the breast(s) with grafts of autologous fat is a non-implant alternative to further surgery after a breast cancer surgery, be it a lumpectomy or a breast removal—simple (total) mastectomy, radical mastectomy, modified radical mastectomy, skin-sparing mastectomy, and subcutaneous (nipple-sparing) mastectomy.  The breast is reconstructed by first applying external tissue expansion to the recipient-site tissues (adipose, glandular) to create a breast-tissue matrix that can be injected with autologous fat grafts (adipocyte tissue); the reconstructed breast has a natural form, look, and feel, and is generally sensate throughout and in the nipple-areola complex (NAC).  The reconstruction of breasts with fat grafts requires a three-month treatment period—begun after 3–5 weeks of external vacuum expansion of the recipient-site tissues.

How is the Explantation Deformity Treated with Fat injections?

The autologous fat injection (graft) replacement of breast implants (saline and silicone) resolves medical complications such as capsular contracture, implant shell rupture, filler leakage (silent rupture), device deflation, and silicone-induced granulomas, which are medical conditions usually requiring re-operation and explantation (breast implant removal). The patient then has the option of surgical or non-implant breast corrections, either replacement of the explanted breast implants or fat-graft breast augmentation. The outcome of the explantation correction is abreast of natural appearance; breasts of volume, form, and feel, although approximately 50% smaller than the explanted breast size, are more significant than the original breast size pre-procedure. Moreover, because fat grafts are biologically sensitive, they cannot survive in the empty implantation pocket; instead, they are injected to and diffused within the breast-tissue matrix (recipient site), replacing approximately 50% of the volume of the removed implant—as permanent breast augmentation.

What are the Technical Limitations of Fat Breast Injection?

It is essential to understand that the graft volume that can be placed directly correlates with the native fat volumes. That is, in patients with more significant amounts of native breast fat, larger volumes may be transplanted and well-vascularized during the healing process. Very thin or patients with primarily no palpable retro-glandular fat deposits may not be ideal candidates for the fat graft augmentation of the breasts or buttocks. It is common for those with minimal recipient site fatty tissues to transfer lower volumes (such as 150 mL or less to each side) and plan on a secondary transfer in 4–6 months.

With the initial stage increasing the volume of fatty tissues, the breasts may adequately accommodate more prominent graft volume placement in the subsequent treatment.  At one year, the average clinical volume increase is estimated at one cup size, with some achieving more considerable enhancements. Although non-surgical breast augmentation with fat graft injections is not associated with implant-related medical complications (filler leakage, deflation, visibility, palpability, capsular contracture),  the achievable breast volumes are physically limited; the large-volume, global breast augmentations realized with breast implants are not possible with the method of structural fat grafting. When the patient’s body has insufficient adipocyte tissue to harvest as an injectable breast filler, a combination of fat grafting and breast implants might provide the desired outcome.

What are the Complications of Fat Breast Injection?

In every surgical and non-surgical procedure, the risk of medical complications exists before, during, and after a process. This is especially true in fat graft breast augmentation, given the sensitive biological nature of breast tissues (adipocyte, glandular). Despite its relative technical simplicity, the injection (grafting) technique for breast augmentation is accompanied by post-procedure complications—fat necrosis, calcification, and sclerotic nodules—which directly influence the technical efficacy of the procedure and of achieving a successful outcome. The use of additives to bioactivate the grafts and recipient bed appears to substantially improve the augmentation achieved and reduce the incidence of lipid cysts, cellular loss, and microcalcifications.

What are the Technical Limitations of Breast Fat Injection?

It is essential to understand that the graft volume that can be placed directly correlates with the native fat volumes. That is, in patients with more significant amounts of native breast fat, larger volumes may be transplanted and well-vascularized during the healing process. Very thin or patients with primarily no palpable retro-glandular fat deposits may not be ideal candidates for the fat graft augmentation of the breasts or buttocks. It is common for those with minimal recipient site fatty tissues to transfer lower volumes (such as 150 mL or less to each side) and plan on a secondary transfer in 4–6 months. With the initial stage increasing the volume of fatty tissues, the breasts may adequately accommodate more prominent graft volume placement in the subsequent treatment. At one year, the average clinical volume increase is estimated at one cup size, with some achieving more considerable enhancements. Although non-surgical breast augmentation with fat graft injections is not associated with implant-related medical complications (filler leakage, deflation, visibility, palpability, capsular contracture),  the achievable breast volumes are physically limited; the large-volume, global breast augmentations realized with breast implants are not possible with the method of structural fat grafting. When the patient’s body has insufficient adipocyte tissue to harvest as an injectable breast filler, a combination of fat grafting and breast implants might provide the desired outcome.

What are the Complications of Breast Fat Injection?

In every surgical and non-surgical procedure, the risk of medical complications exists before, during, and after a process. This is especially true in fat graft breast augmentation, given the sensitive biological nature of breast tissues (adipocyte, glandular). Despite its relative technical simplicity, the injection (grafting) technique for breast augmentation is accompanied by post-procedure complications—fat necrosis, calcification, and sclerotic nodules—which directly influence the technical efficacy of the procedure and of achieving a successful outcome. The use of additives to bioactivate the grafts and recipient bed appears to substantially improve the augmentation achieved and reduce the incidence of lipid cysts, cellular loss, and microcalcifications.

New Trends in Fat Breast injections

The future of autologous fat transplantation may lie in stem-cell research, specifically adipose stromal cells. Mature tissues, such as adipose, contain several stromal cells. Stem cells are smaller, more resilient cells that may be more viable than their mature fat cells. Stem Cells are capable of differentiation to mature fat cells. Developing technology to expand clones of adipose stromal cells would provide a source of filler material for patients who do not have adequate fat for transfer. Other future research endeavors include the development of pre-adipocyte transplants, hormonal manipulation of fat grafts, and the use of growth factors added to harvested tissue to increase the survival of transplanted adipocytes. Adipose tissue-derived stem cells (ADSCs) can be commonly obtained from adipose aspirates after conventional liposuction. Cell-assisted fat transfer ASC-poor fat is converted to ASC-rich fat by supplementing with cells freshly isolated from the adipose tissue during the preparation of the injectable material. The procedure of ASC-enriched fat grafting had excellent feasibility and safety. Results indicate that ASC graft enrichment could render lipofilling a reliable alternative to primary tissue augmentation, such as breast surgery, with allogeneic material or significant flap surgery. Furthermore, ADSCs and their secretory factors promise application in cosmetic dermatology, especially in skin aging.

Breast Fat Injection Results (before and after)

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Breast Implant Surgery. How We Do it?

Breast Augmentation Surgery Results (before and after)

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