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Sunday, 9 February 2014

Could advances in fat grafting spell the end for breast implants?

Fat grafting has come a long way in the last decade or so. The techniques have been refined and remastered and, certainly as far as I am concerned, methods have changed dramatically in the last three years alone.

I remember attending a BAPRAS conference a few years ago and the Birmingham group were presenting their results for autologous breast augmentation using fat grafting techniques. The results were nice enough, but the technique illustrates how things have moved on. They described filling each breast with 250cc of fat at each sitting (most patients were needing two or three attempts to reach their desired volume) and injecting the fat in 1cc aliquots. In addition, they showed a video where they illustrated the 'correct' technique by passing the cannula (the blunt needle that injects the fat) 25 times per 1cc syringe. I put up my hand.

"Excuse me," I said. "I'm no mathematician but, if you are putting 250cc into each breast, doesn't that mean you have to pass that cannula 6,250 times through the breast tissue? Do you have some kind of relay team? Doesn't that cause scarring of the breast tissue?"

I still haven't received a satisfactory answer to my question...

These days, things are different. Using sterile collection devices (such as the Aquavage system or the Lipivage system to name but two), it is possible to remove large volumes of fat in one sitting, purify it quickly and easily, and have it ready for re-injection in a fraction of the time that the old Coleman method took. I no longer use 1cc syringes, but I use 10cc syringes and inject 1cc of fat per pass of the cannula. As you can see in the picture below, it works for me. In this way, large volumes of fat can be transferred in a single sitting and, as long as the patient has enough spare fat (you would be amazed how much spare one can find on even a thin patient) the number of procedures can be minimised.

As this technique continues to evolve, I suspect that we will see an exponential rise in autologous breast augmentation, with implants being reserved for those who do not have enough of their own fat spare to create a breast of their desired volume. I can even envisage a future where, if advances in tissue bioengineering continue at their current pace, even slim women will be able to have their fat cells cultured and re-injected to provide autologous breast augmentation.

Until then we can stick with the flawed, yet safe and predictable, technique of breast implantation. However, ask your surgeon if you are a candidate for fat grafting autologous breast augmentation - who wouldn't want a breast that looks and feels natural, grows and shrinks with the rest of your body and never needs replacing?

Right Mastopexy and Left Fat Grafting

NB The longterm safety of fat grafting is not yet known - it appears to be safe from the evidence so far, but has not been in common practice long enough for us to know for sure. Be aware, be educated, be safe.

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