January 2013 Marie Claire
Most likely, YES. I’ve been doing this fat-transfer-to-the-breasts thing for over three years now and it really is the closest thing to a miracle that exists in plastic surgery. I’ve said it to all of my patients and I’ll say it again: If I hadn’t already had all my fat sucked out ten years ago I would totally have it done in a second. I know I’ve already blogged multiple times about it, but now I would like to address this specific question that everyone who wants to get rid of their breast implants asks me.
Let me start out by saying that I am absolutely all for breast implants. I still put a lot of them in and they’re great. They are. Most of the time. When everything’s good, they usually look better than real breasts of comparable size, because they give you that upper breast fullness that we start losing in our mid-twenties. You can get them done in a way that nobody will know, or in a way that everyone will know and show them off. You can go without wearing a bra. Men like them (see previous post, Do Men Like Breast Implants?) And they don’t sag like natural breast tissue does. Women who come to see me for breast reductions can never understand why anyone would want to make their breasts bigger. It’s simple–DD breast implants defy gravity much better than real DD breasts that hang and pull, causing back and neck pain and bra-strap grooving and rashes.
But, as many of you out there know–and you’re probably the only ones still reading this blog–with breast implants, you’re never out of the woods. They move, they ripple, they (RARELY) rupture (rupture rate of the new Sientra implants recently reported at less than two percent, so that’s good.) They can be great for five years and then, for no reason you develop a capsular contracture (rates reported at anywhere from eight to thirteen percent for all gel implants). Or even worse, you could be one of the unlucky ones who gets a contracture from the beginning, and winds up getting one side removed and replaced three times in less than two years. Dr. Roger Khouri, one of the “fathers” of fat grafting to the breast calls those patients “Implant Cripples.” Sounds harsh, but he makes a point. For some women, they just never work.
So far, my patients and I have been extremely happy with the results with this procedure–removing breast implants from someone who’s “done” with them and re-augmenting with their own fat.
My goal with this particular blog is to help those of you who are genuinely investigating this procedure to understand how it’s being done. When patients ask me about it, they seem to have an image of me just taking out the implants and putting a big glob of fat in the space that’s left behind.
That’s not how it works.
I think that as surgeons, we make the mistake of assuming that our patients have a clear mental picture of the anatomy of their surgery without explaining it to them, and then we’re confused when they don’t understand the limitations and mechanics of a certain procedure.
Just warning you, this is about to get somewhat dry and technical, but is extremely useful information for those of you who really need to know:
Whenever I am discussing a breast procedure with a new patient, I usually draw pictures like the ones below, which are diagrams of where “under the muscle” (left) and “over the muscle” (right) breast implants sit.
The white line around the implant is the “capsule.” This is your own normal scar tissue that has formed around the implant. If this scar tissue becomes thick, it squeezes on the implant, making it feel hard, and that’s a capsular contracture.
When I am switching someone’s implants out for their own fat, after the lipo, I remove the implant through an inframammary (in the crease under your breast) incision. The fat is then placed not in the space where the implant was, but in tiny micro-tunnels in the layers of tissue between the capsule and the skin. This is one of the cases where we say that the “capsule is your friend” because it is keeping the fat from getting into the space where the implant used to be. And it’s okay to leave the capsule there. If we’re not putting a new implant in, and there’s not ruptured silicone all over the place, it doesn’t have to come out. It’s your own tissue and it will eventually reabsorb. A drain is placed in that space (those of you who’ve had multiple breast aug revisions are probably familiar with those) and the space closes down on its own.
How much fat can you get in there?
Depends on how much you have, and how thick the layer of tissue is that I’m putting it in. As you can imagine, it’s better for everyone if your implants are sub-muscular, because then there’s the added layer of muscle to put the fat into. Most of the time I can get enough fat in so that when I’m done, the breasts look almost as big as they did with the implants. In fact, most of my patients who have undergone this procedure laugh about how their friends say, “Are you sure she took them out?” (Obviously they haven’t explained the lipo part of it. :))
But won’t my breasts be saggy afterward?
They might. And you may elect to do a mastopexy (lift.) I personally prefer to wait to do the lift as a second surgery because the breasts get swollen when the fat is placed, and you can get a better lift if you wait till the swelling goes down.
So, for those of you who are considering this procedure, I hope that this blog helped you understand exactly what it’s all about.
Before I leave you–here’s an update on the “Paris Girl” that everyone always asks me about, two years out from her fat transfer to the breast, still wearing a C cup.
She has no scars, and her breasts look and feel so natural in fact, that when she had a little tryst with a member of a royal family over there in Europe…well, I guess you could call it, “The Prince and the Pea.”
We’ve all heard about stem cells. They’re like the millenium’s new “black.” But why, again?
Stem cells are progenitor cells. Think of them as generic cells that can morph into whatever type of cell that surrounds them, as well as enhance the existing cells with extra hormone-type substances—called “growth factors”—that they secrete. There is promising research being done right now that gives us hope that one day adult human stem cells will be used to restore injured tissue after heart attacks, or even spinal cord injuries.
So how did plastic surgeons get involved with something that started out as a potential “magic cure” for heart failure and paralysis?
One of the most exciting discoveries has been that the same fat we’ve been discarding in the hazardous waste containers after liposuction cases (and no, it’s not Fight Club and we don’t make soap with it, as every guy seems to think is the most hilarious question to ask me) is chock full of stem cells. And most of us have at least some of that to spare.
So what does it mean when your surgery is enhanced with your stem cells?
Usually it is a procedure that already involves fat injection. Then it means that your plastic surgeon is additionally using an expensive machine to isolate out an even more concentrated number of stem cells from the fat, and injecting it all back in together wherever the fat is going—usually the face, breasts or buttocks. It also means that you are probably paying extra because the plastic surgeon has to pay off the loan on the machine, and for whatever expensive Google marketing they’re doing to sell their “stem cell” surgeries.
So is it worth the extra money?
There has been promising data regarding the positive effects of fat injection. I have seen it firsthand not only in my “natural breast augmentation” patients, but in cases where it has softened radiated tissue and improved pain and sensation in my breast reconstruction patients. And the science points toward the stem cells and their growth factors as the main reason for this success. However, there is no hard data to prove that isolating out some of the stem cells and then mixing it up with the fat to give you “supercharged stem cell” fat injections is superior to just injecting the fat with its regular stem cell concentration. But the term “Stem Cell” has become as much of a marketing buzz-word as “SmartLipo™” did four years ago (See my Smart Lipo post) and this is where it gets confusing.
My main concern has always been whether or not the additional stem cells are helpful in the “take” of the fat in a natural breast augmentation, as this is a procedure that has become a big part of my practice. I have taken an informal poll of the experts at the meetings, and I have found that it is basically a split camp. In general, many of the plastic surgeons in Japan and the ones here in the U.S. who have stock in the stem cell companies like Cytori are huge stem cell advocates. However, I’ve spoken personally with fat-grafting pioneers such as Dr. Gino Rigotti, Dr. Mel Bircoll and Dr. Roger Khouri, all who disagree.
So far I am personally getting great long-term results in my natural breast augmentation patients without supercharging the fat with more stem cells. In fact, one of my first “guinea pigs” just emailed me some pictures, bragging about how much appreciation her breasts were getting. I believe the direct quote was: “Oh my God, Boobs are so great! They do all the work for you—I don’t even have to open my mouth anymore! I wish I’d done this sooner. When I was younger I used to feel sorry for the girls who had to show off their boobs to get attention, but let me tell you—they were onto something!”
I also did spend a spa day with another one of my first volunteers and although there were no pictures allowed–I can only tell you that she is thrilled and looks amazing; she still weighs 106 pounds and wears a size zero, but she gained two pounds over the holidays and it all went to her boobs.
So could they be better if I used the stem cell machine? Maybe. I have access to stem cell-enhancing technology if the patients want to pay for it, but I don’t feel comfortable pushing it as a “superior” method.
I am a member of both The American Society of Plastic Surgery and The American Society of Aesthetic Plastic Surgeons and the two groups just issued a joint statement, essentially saying that there is not yet any scientific evidence that this expensive extra step of stem-cell enhancement is beneficial.
So what is the take-home message?
If you have been sold a “Stem Cell” procedure, you should understand that what you are getting is fat grafting and while the “stem cell enhancement” may help, there is no proven benefit to the use of additional stem cells in fat transfer. As of now, it is really more a “throwing everything into the pot” approach to getting the fat to take.
In case you are interested, I have copied and pasted the points made in the ASPS/ASAPS January 2012 advisory statement on “stem cell” surgeries:
“…growing concerns have emerged regarding advertising claims and/or clinical practices using stem cells that have not been substantiated by scientific evidence. These concerns include:
* Use of the term “stem cell” in aesthetic surgery procedures, such as the “stem cell face lift,” with the implication of improved results.
* Claims that skin quality can be improved from stem cell treatments, and that outcomes from fat grafting can be improved with stem cell therapy.
* Widespread marketing, evidenced by a Google web search using the search terms “stem cell face lift” yielding 197,000 results and “stem cell breast augmentation yielding 302,000 results, respectively.
* A lack of consistency in how these procedures are performed and how stem cells are incorporated into the procedures.
* Instructional courses, some “for profit,” that have emerged which are designed to teach methods of stem cell extraction for aesthetic procedures.
* Many procedures being advertised by practitioners who are not board certified plastic surgeons or members of other core specialties with formal training in aesthetic procedures. Such “noncore” practitioners have not been trained in an approved residency program designed to teach the physician safe and careful evaluation of cosmetic patients or a working knowledge of the full range of aesthetic procedures.
* Specialized equipment being marketed to physicians for use in “stem cell procedures.”
* Specialized equipment to extract stem cells, including devices, may fall under FDA regulations. Some devices, including automated machines to separate fat stem cells from fat tissues, are not yet approved for human use in the United States.
* Claims of purifying or activating stem cells through techniques that have not been fully verified and tested for safety and efficacy in current, peer-reviewed medical journals, or claims of improved outcomes as a result of these therapies…”
For the full statement you can go to: