Lipofilling the breast
Despite controversy surrounding the use of autologous fat injections in the breast, it is a proven safe and effective procedure, writes Professor Marco Gasparotti
Breast augmentation surgery used to be straightforward, focusing on giving a good shape. A good, simple implant was sufficient. But the industry began to look at anatomical features and then lipofilling, which of course has great advantages depending on the technique and from where you take the fat.
It works very well in the face. We have around 80% survival rate of fat after centrifugation and insertion. We insert it in multiple layers and it lasts—below the dermis, in the muscle, above the periosteum and using a columnar technique.
Lipofilling also works well for refining the mandibular border in facial lifting and for cheek and nose depression.
But we started seeing unpredictable results. We were taking most of the fat from the abdomen, which we no longer use as a source of fat cells. We prefer to use fat from the hip and lateral femoral area, which provides strong, stubborn fat which survives long periods of diet, unlike the abdomen.
My assistant extracts the fat with a 60cc syringe and a 3–4mm cannula. We then use the fat in breast reconstruction to make breasts more symmetrical. We also use it for symmetry after infections.
There is debate about whether the use of fat can advocate cancer, because of the cell duplication. But at the University of Rome, they have carried out thousands of breast reconstructions with fat and implants—they have not reported any cases of cancer in the last ten years.
They haven’t seen any lumps or calcification that could look like a cancer. We have been doing breast augmentation and symmetry correction with fat graft for the last eight to ten years, and have had no problems.
However, I have had some unpredictable results. We have used the technique for reconstruction for Polands Syndrome sufferers—a congenital birth defect causing breast asymmetry.
Since we started to use the lateral femoral and hips rather than the abdomen, we only have to inject the same amount once or twice over a four-month period for a real, predictable result.
We have also been using fat injection for correcting rippling and irregularities with breast implants that occur if the implant is placed below the muscle. We have followed patients for periods of five or six years with our centrifuge fat columnar technique.
One of our patients had capsular contracture following implants and six unsuccessful operations with another provider.
Before removing the capsule for the sixth time and repositioning the implant below the muscle, we spread fat around the area twice over a six-month period. Following treatment, the implants are much softer with no gaps with contracture.
If you inject fat in a capsular contracture, the stem cells can advocate an increase in vascular tissue. We can see improvement in texture following mastectomy, and in capsular contracture.
We have used implants and lipofilling for breast asymmetry to create better projection. We have also used the rejuvenating effect of mesenchymal cells—if, for example, you inject fat into a 60-year-old lady who had implants years before, you can provide rejuvenation. You can also increase breast size slightly through neogenesis.
For symmetry of the lower pole of the breast, we can combine an implant and lipofilling. For symmetry of the upper pole, we can also improve symmetry of the rib and chest wall.
One of our patients had no pectoral muscle but had had implants. We carried out normal centrifugation of the fat, and did one breast with centrifugation and the other without.
Results showed that centrifugation must only be used for minimal correction or small defects, perhaps in the face. When you have to add a lot of volume, such as for the breasts, it doesn’t seem to make any difference.
We are now investigating the freezing and conservation of fat cells in a bank. We started collecting fat with a special needle and a special close-assisted syringe.
We collected the fat in special bags that enables the fat to freeze on one layer—the cells will freeze harmoniously. We shipped the fat to the Belgian Cryo-Lip lab, part of Cryo-Save, a global bank for umbilical chord stem cell storage.
They then send us as much as fat as we need every three or four months for reinjection. We carried out studies on cell survival after freezing and there was no difference.
So we freeze the fat because it’s uncomfortable for patients to come back twice or three times for more fat removal. We remove it in one stage, freeze it and ask the bank to send back to us as much as we need.
We have better results now that we remove from a long-lasting area like the hips and lateral femoral. The procedure is very effective in asymmetries or tubular breasts and breast reconstruction. There is a place for lipofilling—while we have not yet found any added risk of cancer, we have learned a lot and still have much to learn about the technique.
Professor Marco Gasparotti is a consultant plastic surgeon in Italy