Breast augmentation with fat injection, also referred to as lipoaugmentation or lipofilling, has become increasingly popular in recent years. Used in numerous procedures, it was considered one of America’s fastest growing ways to augment breasts cosmetically. The fundamental principle of using fat to augment breasts for aesthetic purposes is compelling. It is an autologous material easily harvested, manipulated, and injected, free from some of the risks associated with foreign materials like breast implants. By comparison, the scientific principles involving breast augmentation with fat injection have been relatively understudied for many reasons, including factors of donor-site biology, transfer technique, graft survival, and remodeling.
Treatment with fat injection reportedly provides a natural, soft texture and appearance that integrates well with patients when querying the desirable goals of breast augmentation. However, the process of harvesting, transferring, and conforming the breasts to desired outcomes comes at what could be considered a high price: on wounding to harvest fat, the body has a cellular level response of mobilizing numerous pro-inflammatory cytokines. The aesthetic appeal of a breast can be described as having attributes associated with classical elements such as dimensions, proportions, landmarks, and symmetry. The role of the plastic surgeon has always been that of an artist attempting to bring these attributes back to a breast in which they have been lost due to alterations. Historically, fat injections have been explored as an aesthetic reconstructive option and have had a long track record in breast oncology. Since the advent of technology, particularly microcannula and centrifuge technology, reliable and predictable approaches to breast grafting are popular treatments sought out by patients. Moreover, scientific research in the field has allowed individuals to more precisely harvest, prepare, and understand fat graft survival limitations and optimization strategies.
Determining the suitability for breast fat injection is a matter of careful consideration of the following factors:
The general health status and history of the patient must be thoroughly investigated, including the general physical state, chronic diseases, and psychological status. Full consent must be obtained before any procedures are performed, including the customer’s understanding of the expected outcome. Conditions and consultations: Probably some of the most important questions to ask during patient consultations when considering breast fat transfer revolve around why the patient is seeking the procedure. Although patients are encouraged to exercise and maintain a balanced lifestyle, significant weight gain or loss through surgery should not be undertaken over the following three-month period. Detailed examination steps and the “second look” meeting that patients and physicians should conduct are important. It is estimated that 5–10% of patients seeking large fat injections stand a good chance of developing necrosis. Therefore, most patients seeking large fat injections can be discouraged and advised that they may require planned multiple sessions if they wish to add additional volumes following the first injection.
The recovery period for fat injection to the breasts, as in any form of liposuction, requires a few days for the swelling to resolve. On a scale of days, not weeks, you start to feel more comfortable with the bruising getting lighter. The first few nights trying to sleep should be spent in a slightly flexed position (to protect the knees at the same time, if you can manage it), and it is preferable to sleep mostly on the back for about one week. It’s quite normal to experience post-operative bruising and swelling that can involve not only the breast area but also the abdomen, hips, and thighs. The breasts also look swollen, often one more than the other. All these signs are part of the healing process that will resolve in just a few days. Discomfort is a good thing. It reminds you every time you experience it that you have had surgery, and it prevents you from doing too much too soon. If you didn’t feel any discomfort, you would be tempted to overdo your level of exercise and compromise the long-term planning.
Recovery and comfort returning to the point of not taking any medication are different for different individuals, but expect one or two weeks of discomfort altogether. Each person is unique in the recovery process. What you read and hear from patients is a generalization. Any limitations in activities are short-lived. A big exception is the care and attention, of course. Gentle physical activity, such as short walks for exercise, is important to reduce the potential for blood clots in the initial post-operative phase, but it is equally important not to overdo activity until your body has the chance to both heal and then recapture fitness. It can also be helpful to do deep breathing exercises to reduce cramps in the shoulder that can occur with upper body or chest surgery. Rest and following the post-operative instructions are of tremendous importance during the healing phase (feet up and let the body do the work of tissue recovery). Keep all follow-up appointments. The psychological steps in recovery take longer. It usually takes at least three months and often over twelve months for the breasts to adopt their new shape and for the recipient to feel comfortable with their new body. Withdrawal from anesthesia takes days. Expect mood changes in the first few days post-op. An emotional high is soon replaced by depression. Often you cannot fathom why you feel down after one day of feeling up. Evening depression is common. In the second week post-op, most patients are doing well; however, it is possible that again in the evening hours it is common to ‘go over the edge.’ Be kind to yourself and trust that it is short-lived and will change soon. Monitor your general health. If a fever is present, contact your doctor. Your doctor will see you in the office in 2 to 3 days post-op to evaluate the initial healing, and the stitches or tapes will be removed in 7 to 10 days. You should be seen on a follow-up basis for subsequent checks and advice, but most patients live away from us, so future follow-up can be done locally. If you have any concerns, see your general practitioner. The majority of patients are back to work after the post-op check at 1 to 2 weeks. Some are back to work the next week if the job involves improper physical exertion. Your comfort is the measure, that of sitting as well as moving around in the workplace, and if your office work is sedentary, you may well function outside the home a few days following surgery. A reasonable expectation for recovery from fatigue and the re-establishment of stamina for work and other activities is about 2 weeks.
Patients will be provided with aftercare guidelines specific to their particular procedure, including such things as activity restrictions, how to care for the areas where fat was injected, and how to help the skin heal as best as possible. Any and all written recommendations your healthcare providers make should be regarded thoroughly and carefully if you want to achieve and maintain optimal results and reduce the chances of complications after having fat transfer to your breasts. Be aware that the subcutaneous fat in your breasts that was injected does behave the same with respect to weight loss and gain, and aging affects the skin and accepts the subcutaneous fat adopted in whichever part of the body you may have experienced these. You should not overeat and certainly not remain overweight because you have had this procedure. Additionally, married women should avoid becoming pregnant if possible, as pregnancy can adversely affect the results of the fat transfer and make the breasts smaller. Attainable results can be maintained with good personal health maintenance and staying in tune with one’s body to note immediate changes. Aging and normal fat absorption may also affect long-term results and the cosmetic appearance of the breasts; small touch-up or maintenance fat injections can help maintain the youthful cultivated appearance.
The mental and emotional well-being of a patient at this phase should also be assessed during the follow-up visit, as emotional and mental health reflects one’s overall health mentally, physically, and emotionally. Counseling or some type of mental/emotional health maintenance would not be inappropriate to recommend. If one chooses to endure fat transfer to mammary tissue for cosmetic purposes and has realistic and achievable results, proper nutrition and positive self-care of oneself throughout the postoperative process should be the subsequent regulation.
While recovery is different for everyone and depends in part on how much of the body was treated for fat removal in addition to the breast, most people need about a week to ten days at home to rest and recover before doing normal activities. Swelling, bruising, and tenderness are typical at the start of recovery but subside fully typically within the first two weeks.
Cost varies depending on your geographic region, the specific treatment plan, as well as inclusions like anesthesia, facility, and aftercare fees. On top of that, larger areas having more fat removed will typically impact the overall cost as well. We make sure to break down the expected costs and review them with each patient at their initial consultation so there are no surprise fees.
Because about 20-30% of the fat grafted cells will not be able to sustain themselves long term, the fat that remains a small period after surgery is permanent. A majority of women do see results from their fat injections long term.
You and your surgeon will have to discuss what type of procedure is best for you, based on health history, physical examination, aesthetic goals, and so on. It is important to note that, while fat transfers may seem safer since they use the body’s own fat, they do remove fat in an invasive manner, which has its own risks.
Yes, as long as it is done correctly. For fat to be an effective volume-enhancing breast treatment, you will have to keep in mind that some of the fat will be resorbed (usually about 20-30%). Successful fat grafting is also based on choosing the right patient: women who are interested in a ½ to 1 cup size increase and have unwanted fullness in other areas will have a more successful fat transfer than those looking for multiple cup size jumps.
Swelling, bruising, mild pain, sensitivity, and numbness are common side effects that you may experience following your procedure.
If your procedure is primarily fat grafting, typically you are outpatient, can go home the same day, and are awake, relaxed, and comfortable with oral and IV sedation anesthesia.
Most patients will need 1-3 sessions of fat grafting, depending on the amount of size increase wanted and if there was a specific surgical goal. Goal size and how much fat you need will be determined primarily by volume and density measurements done at your consultation and surgery if one procedure was initially elected.
Final results of a fat transfer to the breast are typically seen about six months after your final treatment. It’s important to understand that you will most likely need more than one procedure to reach your goal, so if you have three treatments, your final results will be in six months from your third surgery. It’s also important to note that if major weight changes occur or pregnancy is experienced in the future, this could alter your outcome
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