Fat transfer (fat grafting or lipofilling) to breasts is a dynamic procedure which has gained immense popularity for augmenting various parts of the body. The technique involves aspirating fat through special small diameter cannulae. The fat is then treated to remove oil and excess water. This leaves concentrated fat cells which are gently re-injected to fill out the desired area.
The whole concept is based on ‘structural fat grafting’. Fat cells injected by this special method lie in different tissue planes and are able to get an individual blood supply. The end result is that the fat injected persists long term. It is estimated that about 40 to 70% of the fat injected survives long term and we overcompensate at the initial surgery, anticipating the loss. However, top up procedures may be necessary. The additional benefit of fat transfer is the therapeutic effect of stem cells which are present in fat cells. This has an emerging role in tissue regeneration and wound healing.
What are the risks and side effects of surgery?
Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of possible complications.
There will be some discomfort for the first day. Occasionally bruising may occur, but this should resolve rapidly.
Scars are very small and hidden in a skin crease. They should be barely perceptible. However, some patients heal with thick scars and this can make them more noticeable. There are no scars on the breast, as a needle is used to inject the fat.
Bruising and swelling
This is very common and bruising may take a couple of weeks to settle.
Infection is rare but may require a course of antibiotics.
Of the fat that is injected, 40-70% should ‘take’ and become permanent. The remaining fat will simply melt away (reabsorb) over the next few weeks. If further fat is required, then the procedure can be repeated after 12 weeks or more.
Breast cancer development
There are theoretical concerns about the possible effects of fat transfer on the development of breast cancer. However, to date, there is no evidence that fat injected into the breast causes breast cancer. Thousands of fat transfer procedures have been performed world-wide, many in breast cancer patients, and an increase in breast cancer rates has so far not occurred. However, it will take many years and experience with thousands of patients before the scientific community can determine with certainty from robust data that breast fat transfer will not contribute to breast tumor growth.
Numbness, reduced sensation or oversensitivity
Numbness, reduced sensation or oversensitivity can occur in the nipple or breast. This is usually temporary, but occasionally these changes can remain to some degree.
Implant rippling or wrinkling
Implant rippling or wrinkling can be more of a problem in very slim patients or those who have very little breast tissue. However, the chances are reduced if the implant is placed behind the chest muscles.
Concerns have been raised that fat transfer can alter the appearance of the breasts on mammogram, ultrasound, and MRI. Breast lumps, cysts, and calcifications can occur after breast fat transfer, just as they can after other breast procedures. The developing consensus is that transferred fat looks distinct on breast imaging and is generally distinguishable from lesions suspicious for breast cancer.
Fat cysts can sometimes occur after fat transfer. Most cysts can be aspirated with a needle if they are problematic.
If some of the fat does not gain a blood supply it will die and gradually be reabsorbed. This can sometimes leave a lump that cannot be seen but can be felt. Massaging should resolve this but occasionally a procedure to remove the lump may be required.
Further fat transfer procedures
These are sometimes to give the desired result. Only a certain amount of fat can be injected during one operation. If you desire more volume then a second procedure gives the flexibility to add this.
Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are immobile.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to contact me. Decisions about cosmetic surgery should never be rushed and requires personal research.
What happens after the operation?
At the end of the procedure, a light waterproof dressing may be placed over the stab incision where the fat was harvested. This can either be on your abdomen or thigh.
I would recommend that you wear a support bra for 2-4 weeks following your surgery. This will help shape the breast and provide comfort whilst the bruising settles.
As long as you are feeling well after the operation, you will be able to go home the same day. You will not be able to drive yourself home from hospital, so it is often a good idea to ask someone to help you.
Before you leave the hospital, a 1week follow up appointment will be booked with the nurse to check everything is settling well. I will normally see you in clinic in 8-12 weeks.
What is the estimated time for recovery, absence from work and return to usual activities?
Recovery times vary from one person to another. Depending on the amount of fat transfer, you can return to work after 1 to 2 weeks. If you have any concerns during this period, do contact the hospital team for advice.