Monday, November 2, 2009

Update on Breast Augmentation Using Fat Injections

A new study on fat grafting for breast augmentation was presented at last week’s American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference which I wasn’t able to attend.  The ASPS News Brief section gave an update on the presentation with a pdf of the abstract.

The main study author, Roger Khouri, MD, FACS, is featured in a video explaining the study and technique.  He feels that his study of 50 women is enough to settle the question of safety and effectiveness of fat injections for cosmetic breast augmentation.  Even though his results are good, I remain a skeptic. 

The study involved 50 women, ages 17-63.  Initially the length of surgery was 5 hours.  This decreased as their learning curve and technique improved to 1.5 hours.  Each woman received 250 cc of fat injected into each breast.  Five women had a second procedure (unclear if this was due to fat graft loss or desire further increased size).  All patients are reported to have returned to their normal activities within 3-4 days.

The procedure involved using atraumatic low pressure harvesting of the fat with fine cannulas, minimal fat manipulation, and diffuse periglandular graft placement as microdroplets through multiple injection ports in a pre-expanded, hypervascular bed.  This “pre-expanded, hypervascular” bed was obtained by having the patients wear a bra-like (external) tissue expander device several weeks before and after surgery.  This device is called the Brava.

[Keep the use of the Brava in mind as you continue reading.  If the Brava truly gains the 100 cc of breast growth on it’s own (as reported on its website), then the volumes and fat survival obtained by the fat grafting should possibly be refigured with this taken into account.]

MRI’s were done to access volume.

Breast volume was unchanged between the 3 and 6 months MRI measurements (p>0.2).  Thus the 3month MRI was discontinued for the remainder of the study. Average augmentation volume at 6-12 months MRI was 210 ml/breast (90ml - 360ml).

On long-term follow up, breast volume changes were commensurate with BMI fluctuations. Graft survival averaged 85% (70% - 120%). There was a direct correlation between maximal pre-grafting expansion and the resultant final breast volume augmentation.

The study authors report no suspicious breast masses or nodules.   There was an 18% incidence of fat necrosis noted on the MRI’s, all of which were identified on the one-year mammogram identified.  The authors state “More importantly, the radiologist had no difficulty interpreting any of the studies.”  There is one reported infection.

The researchers report good patient satisfaction with an average increase in breast volume at 6-12 months was 210 ml (in my experience slightly less than one bra cup size).  The fat graft survival achieved averaged 85% of the actual fat injected volume. 

The main drawbacks reported by the researchers  include changes in breast volume are proportionate with BMI fluctuations. 

ASPS reports that breast augmentation was the most popular cosmetic surgical procedure in 2008, with more than 307,000 procedures performed.  It's also the most commonly requested procedure among women.

 

 

REFERENCES

Study:  "Autologous Breast Augmentation with Liposuctioned Fat: A Fifty Patient Prospective Study Over Five Years" is being presented Sat., Oct. 24, 1:00 - 1:05PM PDT, at the Washington State Convention and Trade Center.  (abstract—pdf file)

American Society of Plastic Surgeons News Brief (October 24, 2009)

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