Breast augmentation with grafting of liposuctioned fat:

• Objective:
  Gynecologists are frequently asked by their patients about breast augmentation. There have been only two effective treatments: breast augmentation with implants and non-surgical breast enhancement with an external tissue expansion device. This study investigates whether breast augmentation with liposuctioned fat is a safe and effective alternative to breast augmentation, given the advancements made in harvesting techniques, refinement of surgical instrumentation and preparation of the graft site.
• Methods
  After 4 weeks of vacuum external breast expansion with the BravaŽ System, 2b women underwent 11 bilateral breast augmentations with lipotransfer. 90-300ml of decanted low-pressure aspirated fat was re-injected in a 3-D fanning pattern in the expanded subcutaneous periglandular space. Postoperatively expanders were used for 1 week as stabilization stents. Breast volumes were derived from 3D reconstructions of the baseline, 3 and 6 months post­operative MRIs. Mammography was performed at one year.
• Results
  At 12-30 months follow-up, there are no complications; no nodules, no suspicious radiographic findings and all patients were satisfied with their results. 20% have typical fat necrosis calcifications identified on MRI imaging. Average augmentation is 180ml/ breast per lipotransfer procedure (range 90-230 ml). Graft survival averages 90% (range 70-100%).
• Conclusions
  Single-stage, large-volume lipotransfer breast augmentation is feasible in a prepared, expanded, hypervascularized bed with a predictable 90% graft survival. Fat necrosis is a rare finding recognizable by modem breast imaging. Most importantly, the procedure does not distort the breast tissue or interfere with breast cancer detection. Subcutaneous autologous fat grafting safely and effectively augments the breast.

The primary objective of tliis study is to determine whether autologous fat grafting to the breast, utilizing a negative pressure external soft-tissue device to expand and prepare the recipient graft site in conjunction with refinements in fat harvesting techniques and microfat transfer, is a viable option for breast augmentation and reconstruction.

• In 1987, tlie American Society of Plastic and Reconstructive Surgeons institute a ban on fat grafting to the breast because of poor graft survival, fat necrosis and limited breast imaging.
• Today, radiologists can clearly differentiate neoplastic properties from fat necrosis.
• Micro fat grafting has been markedly improved with refinements made in harvesting teclmiques. preparation of the graft site and specialized instrumentation.
• In addition Brava , an external breast tissue expander, was found to increase the vascularity of the breast and to temporarily expand the extracellular and extra glandular preferred recipient site.

• IRB approval
• Baseline MRI:
• confirm no pathology
• precise volume determination
• 4 weeks of Brava use for external breast expansion (>10 hours/day)
• Uninterrupted BravaŽ usage for 72 lirs hours prior to surgery
• Local anesthesia with sedation
• Harvest 200-300 ml of fat with atraumatic Coleman cannulas
• Inject breasts in a multiplanar, multidirectional weave partem
• Begin wearing Brava 12 hours post-op. Next 36 hours, wear continuously as tolerated. Followed bv ;>10 hours/day for 5 to 7 days
• MRI performed at 3 months and 6 months:
• % of fat take
• Volume of enhancement
• Presence of fat necrosis
• Mammography at 1 year

External Tissue Expansion Augments theRecipient Matrix

Pre-op Markings On Expanded Recipient Site

Peri-Glandular 3D Diffuse: Infiltration of Fat Grafts Using a 14G CannulaThrough 20 Puncture Sites

• 27 Bilateral Breast Lipo-Augmentation:
      Average F/U 20 months (Range 12 - 30 months)
• Average volume injected/grafting session:
      220ml (Range: 90 - 300ml)
• Average breast enlargement measured bv MRI
      180ml (Range: 90 - 280ml); 240ml on last 6 cases
• Average graft survival:
      90% (Range: 70 -100%)
• Normal breast exam:
      with no suspicious nodules or masses
• No significant change between 3 & 6 months follow up
      noted on MRI
• Foci of fat necrosis identifiable on MRI & Mammography (20%)

MRI: Pre and Post

32 y.o., post Mastopexy and G. Bypass 2 Lipo-Augmentation sessions 380 cc Injected/B 18 mo. F/U, 300 cc Vol. Augmented, 80% TakeNo fat necrosis

44 y.o. - One Lipo-Augmentation session 170 cc Injected/B 2 year F/U, 150 cc Vol Augmented, 90% TakeFat necrosis on MRI and MG

26 y.o., One Lipo-Augmentation session210 cc Injected/B 18 mo, F/U, 180 cc Vol. Augmented, 85% TakeNo fat necrosis

20 y.o., One Lipo-Augmentation session220 cc Injected/B 9 mo. F/U, 200 cc Vol. Augmented, 95% Take No fat necrosis

Single-stage, large-volume lipotransfer breast augmentation is feasible in a prepared, expanded, hypervascularized bed with a predictable 90% graft survival. Fat necrosis was present in 20% of the grafted breasts and was recognizable by modem breast imaging. Most importantly, the procedure does not distort tlie breast tissue or interfere with breast cancer detection. This method can be utilized for collection of breast asymmetry and deformities, breast reconstruction, fillers for post implant removal and simple aesthetic breast augmentation. Future applications and studies utilizing fat grafting for patients with breast asymmetry following lumpectomy and radiation therapy is currently being investigated. Fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures.

1.    Khouri, R K, Schlenz, I., Murphy, B. J., et al. Nonsurgical breast enlargement using an external soft-tissue expansion system. Plast. &,Reconstr. Surg. 105:2500, 2000.

2.    De Filippo, R.E. and Atala, A. Stretch and growth: the molecular and physiologic influences of tissue expansion. Plast. & Reconstr. Surg. 109:2450, 2002.

3.    Coleman, S R. and Saboeiro, A Fat grafting to the breast revisited: safety and efficacy Plast. & Reconstr. Surg. 119: 775, 2007.