Breast Fat Grafting: 10-Year Learned Clinical Experience

Our being strives for staying youthful and being beautiful. Beauty for woman encompasses the entire body from the face, down to the breasts, the torso, buttocks, and extremities. Breast enhancement using implants is consistently ranked as one of the most common aesthetic surgical procedure undertaken by woman. However, as alloplastic implants suffer numerous potential complications and revision surgery, some practitioners and patients seek alternative treatment. Autologous fat grafting has gained popularity due to its safety and scientific advances yielding increased adipocyte survival. The low complication rate and valuable cosmetic outcomes will continue to have patients request natural breast augmentation. The authors’ more than 12 years of clinical experience with autologous fat transfer to the breast is presented. Advances in fat processing, enrichment, and administration are highlighted. The addition of stem cells, stromal vascular fraction, and platelet-rich plasma (PRP) is elucidated during the clinical experience. Laboratory evaluation of fat survival comparing ultrasound- and suction-assisted fat harvesting is presented. A comparison of 2 distinct fat processing methods is done using both clinical evaluation by the patients and surgeon, and the use of diagnostic ultrasound to assess fat thickness before and after surgical placement. The filtration device (Puregraft, Solana Beach, California) was compared with the Lipokit or filtration, centrifugation device (Medi-Khan USA, Inc., Los Angeles, California). Breast fat grafting was used for sole breast augmentation, after silicone breast implant surgery, in conjunction with mammopexy surgery, and reconstruction after breast cancer surgery or explantation. The authors’ observation with breast fat grafting volumetric outcomes has seen an increase from about 30% to almost 80%. This increased volume is related to the placement of a purer fat graft with less wetting solution fluid with less blood and oil. Minimizing ultrasound energy during the harvesting, lower suction levels, short fat storage times of 1 to 2 hours prior to administration, purification of fat without washing away growth factors, and the enrichment of fat with fat-derived autologous stem cells and blood-derived PRP have been observed techniques to optimize fat survival. Breast fat grafting using much of the current knowledge of harvesting, processing, enrichment, and administration has yielded superior adipocyte survival. This increased survival has provided more consistent breast enhancement results.