Pros and Cons of Autologous Breast Augmentation

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Some women like the idea of having bigger breasts, but don't like the idea of breast implants. Breast augmentation with fat is technically known as autologous breast augmentation.

This procedure uses a woman's own fat instead of breast implants to increase the size of the breasts. The fat is liposuctioned from a body area with excess fat and then injected into the breasts for augmentation.

About the Procedure

Initially, the American Society of Plastic Surgeons (ASPS) did not recommend the use of fat grafting for breast augmentation.

In 1987, the ASPS indicated that because of the side effects (i.e., dense lumps, oil cysts, and calcifications), autologous fat grafting to the breast might compromise breast cancer surveillance and should, therefore, be prohibited. Most plastic surgeons stopped performing the procedure.

More recently, the ASPS Fat Graft Task Force has stated that there is no strong evidence for or against autologous breast augmentation.

This procedure has also been referred to as "stem cell breast augmentation." This label is a misnomer. Fat removed by liposuction contains stem cells. A stem cell is a cell that can develop into different types of tissue, based on where it is placed in the body.

Stem cells alone cannot be injected into the breast and expected to increase breast size. The stem cells must be combined with fat. Hence, the term "stem cell breast augmentation" is not entirely accurate.

Before considering this technique for augmentation, a woman needs to consider not only the enhancement expected, but also possible long-term effects associated with the fat transfer to the breast.

Advantages
  • No implant used

  • Small incisions

  • Uses woman's own fat

  • Relatively low complication rate

  • Breasts look and feel natural

  • Good safety record

  • Patients and doctors are satisfied with the results

Disadvantages
  • No standard technique

  • Only enlarges one cup size

  • Breast lift may still be needed

  • Fat may be reabsorbed

  • Calcifications may interfere with breast cancer imaging

  • Must have enough spare fat to transfer

Advantages

In breast augmentation using autologous transfer, fat is liposuctioned from areas of excess and is then injected into the breasts for augmentation.

The benefit is that since a woman is using her own fat, there is no need for an implant. If the fat heals well, the breasts look and feel normal. Additionally, the only incisions are the 4-millimeter incisions used to remove (liposuction) and re-inject the fat.

In addition, if an individual has grade 1 ptosis (sagging breasts), fat grafting to the breast is ideal, because a looser pocket allows for a greater percentage of fat surviving, compared to a tight breast or ptosis stage 2 or higher

When used to augment healthy breasts, the procedure has a good track record, with few complications or need for re-operation as compared to implant-based augmentation.

Reviews of cases where it has been used for breast reconstruction have found that it has a relatively low complication rate and that most women and their doctors are satisfied with the results. Studies have also found that it does not promote cancer recurrence or complications.

Disadvantages

Compared to breast augmentation with implants, there are several disadvantages to autologous breast augmentation. Although detailed descriptions of how to obtain, prepare, and inject fat have been described in the plastic surgery literature, there is no standard technique for autologous breast augmentation.

For this reason, you'll want to be sure to seek out a surgeon with a long and successful track record of performing this procedure. It is also essential that any woman seeking breast augmentation with fat is aware of the disadvantages and limitations when compared to traditional breast augmentation. 

One Cup Size Limitation

Breast enlargement is usually limited to one cup size. While the external tissue-expansion system increases blood flow to the breasts, it is not enough to instantly support a large amount of fat.

Because the fat does not have its own blood supply to keep it alive, a limited amount of fat can be injected. At most, an A-cup breast will increase to a B-cup. With breast implants, there is no such limitation.

Minimal to No Breast Lift

If a woman has ptotic (sagging) breasts, autologous breast augmentation will not improve the problem. She will still need a breast lift to improve the sagging.

Unpredictable Survival of the Fat

Because the fat does not have its own blood supply to keep it alive, it relies on the blood supply already in the breast. Consequently, a limited amount of fat can be injected.

If more fat is injected than can be supported, the fat will be reabsorbed and possibly harden. In addition, this fat resorption means a reduced resulting increase in breast size.

Breast-Screening Concerns

Fat injection may interfere with breast-screening examinations. The volume of fat required to enlarge the breast makes the technique prone to calcification. These calcifications will be visible on a mammogram. These changes will be present over a woman's lifetime.

The pattern of those calcifications is different from calcifications associated with breast cancer. However, they may result in the need for more frequent breast biopsies, especially if there is a strong history of breast cancer in the family. A lifetime of close monitoring and follow-up may be necessary.

Before a fat-grafting procedure, it is best to have a mammogram taken to retain for future reference. It will help your health care team distinguish between new calcifications versus those that result from the graft.

Amount of Fat Needed

A sufficient amount of fat is needed: in order to effectively increase breast size, sufficient body fat to harvest at least 1,000 milliliters of pure fat is needed. Lean women are not good candidates for this procedure.

Must Be Motivated

The best candidates for this procedure are self-motivated individuals, as the external expansion process is self-directed after an initial consultation with the surgeon.

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  2. Villani F, Caviggioli F, Giannasi S, Klinger M, Klinger F. Current applications and safety of autologous fat grafts: a report of the ASPS Fat Graft Task ForcePlast Reconstr Surg. 2010;125(2):758-759. doi:10.1097/PRS.0b013e3181c722cf

  3. Groen J-W, Negenborn VL, Twisk JW, Ket JC, Mullender MG, Smit JM. Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon SatisfactionAesthetic Surgery Journal. 2016;36(9):993-1007. doi:10.1093/asj/sjw105.

  4. Salibian AA, Frey JD, Bekisz JM, Choi M, Karp NS. Fat Grafting and Breast Augmentation: A Systematic Review of Primary Composite Augmentation. Plast Reconstr Surg Glob Open. 2019;7(7):e2340.  doi:10.1097/GOX.0000000000002340

  5. Petit JY, Botteri E, Lohsiriwat V, et al. Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Oncol. 2012;23(3):582-8. doi:10.1093/annonc/mdr158

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