Fat grafting is a fabulous, relatively recent development in plastic surgery. Patients often ask, "can't you take some from here and put it over here?" The answer is now yes. We can harvest fat from one location using liposuction, process it, and inject it into another location, with approximately 75% long-term viability of the fat. Initially there can be a significant degree of swelling - for about 1-3 weeks - and also we deliberately "overcorrect" by injecting more fat than we need to compensate for the 25% loss that occurs over 6 weeks. Most of the important ground-breaking work in this field has been done by Dr. Sidney Coleman of New York.
AFT (our fancy term, meaning autologous fat transfer) is most commonly accepted for use in the face. When injected into naso-labial folds, deep creases, or the lips, it acts as a permanent filler. Although sometimes it takes two rounds to get a perfect result in these areas, the advantage is that the fat is your own tissue, and thus lasts indefinitely, as opposed to off-the-shelf fillers such as collagen and hyaluronic acid. We still use hyaluronic acid a lot, but we offer AFT as an alternative, if the patient is willing to go through a bit more extensive of a procedure.
Photo of the specially prepared fat harvested with liposuction by Dr. Borud, ready for re-injection to a recipient site such as the buttock, breast, or face:
The most exciting new development is that we have been using larger-volume, more aggressive fat transfers for achieving substantial changes in the buttock and breast, as well as using this to correct contour depressions from previous liposuction. Many cosmetic patients are paying much more attention to the shape of their buttocks. Buttock implants can be a good option, but in many cases they are not ideal. With fat injection, we can place the additional tissue exactly where it is needed. This usually involves one or two procedures under anesthesia as an outpatient.
The use of large-volume fat injections for breast augmentation is still controversial. I frequently use fat transfer to the breasts for "touching up" breast implants or adding to the ICAP-flap augmentations we use in the MWL patients. I have just started doing breast augmentations using only fat-transfers rather than implants. This is appropriate mainly for patients who have good nipple position already and do not need a simultaneous "breast lift." The United States is behind in this area because of a 1989 position statement by one of our national societies which came out against fat injection into breasts because of a theoretical concern that it could hamper mammographic testing. Dr. Coleman has recently published the first US paper on AFT for breast augmentation, and he points out that the 1989 committee quoted no references and had no scientific backing for its position. In fact, other commonly done procedures such as breast reduction, TRAM flap breast reconstruction, and others, are known to cause some mammographic artifacts. Yet these procedures are "OK", even though AFT was condemned due to theoretical concerns that it may cause some mammographic artifacts which are proven to be present with these other widely accepted surgeries.
In any case, I tell breast patients about the 1989 position paper, simply as part of an informed consent. However, I feel completely comfortable doing the procedure if the patient has all the adequate information and wants to proceed. Most AFT breast augmentations have been performed in Europe - one location in France and one location in Italy. We usually require two or three stages under anesthesia to attain a 300cc or higher result comparable to a large breast implant, especially in thinner patients. We are more able to complete the work in one stage if the patient has "enough fat" elsewhere on their body to harvest for the transplant. In really thin patients, we cannot always obtain enough fat to transplant!