Fat is harvested in small pieces by liposculpture. The donor sites of choice are the natural fat deposits where volume reduction may be of aesthetic benefit, such as the waistline, the abdomen, the hips, the inner aspects of the thighs and the knees. When necessary, fat may also be aspirated homogeneously from the anterior and lateral aspects of the thighs.
For lipofilling the fat is filtered and reinjected under the skin and in the breast through stab incisions of only a few millimetres.
There are limitations to the volume that can be used for breast enhancement. The transferred fat can only survive in healthy tissue with good blood perfusion. After excessive fat injection, a higher percentage of fat does not take and is reabsorbed. Thus one session of lipofilling can rarely create as much volume as classic breast augmentation with implants. A combination of breast implants and lipofilling can be useful in slender ladies, to better cover the border of the implant and rippling of its surface with living tissue.
Breast augmentation with autologous fat is a recent surgical technique. It has been introduced about ten years after lipofilling to other areas of the body such as the face and the buttocks. One woman out of nine is confronted with breast cancer in the course of her life. Therefore, extra care and diligence were appropriate to introduce fat transfer to the breast.
Fat tissue secretes certain hormones. A part of the transferred fat dies off and forms oil droplets. After some other surgical procedures, such as removal of a breast lump or breast reduction, there may also be some localised areas where fat dies. It has never been demonstrated in these other operations that local fat necrosis would increase the risk of breast cancer.
Microscopic calcifications may form in oil droplets. It is an extra challenge for radiologists who evaluate mammograms to distinguish these calcifications from another type of calcifications that may appear in breast cancer. Mammography is an important technical examination in the early detection of breast cancer.
Since results on hundreds of patients from the pioneers in fat transplantation have been followed up for more than ten years, more and more plastic surgeons take up this treatment. Present data do not give statistical evidence over a whole human lifespan. There is no medical treatment without inherent risks. Advantages, disadvantages and uncertainties about fat transplantation have to be balanced against the well-known advantages and disadvantages of breast augmentation with implants.
Breast augmentation by lipofilling requires day admission ore one overnight stay in the hospital. The pain is moderate. Strong pain killers are necessary for one to two days. There is pain like after excessive exercise for two to three weeks. In general, the eventual volume of the breasts is reached after three months. The risk of irregularities, imperfections of shape or contour, hardening that remains longer that normal cannot be excluded completely.
Adequate follow-up is mandatory after lipofilling of the breasts. The evolution can be documented adequately by examinations by the plastic surgeon and the gynaecologist on a regular basis, ultrasound, MRI scan, and, for certain age groups and risk groups, mammography.
