The Future is Now
Fat grafting for aesthetic purposes has always been a thing of science fiction. Every plastic surgeon has had women come into their office and say “can’t you take it from here” (pointing to their hips) “ and put it up here”(pointing to their breasts. Now the future is here in Minneapolis, autologous fat grafting is being used for primary breast augmentation around the world.
The first International Fat Grafting Forum was held in New Orleans this past fall and I was able to attend this very interesting and informative session. There was a core of international plastic surgeons specializing in fat grafting to share their experience. They discussed new technologies and techniques to improve graft survival and minimize complications using fact based science and experience. These leading practitioners in the field of fat grafting discussed their experience and the controversies surrounding the topic.
Controversies Put to Rest
The experts discussed the radiologic changes to the breast that occurs with fat grafting and how they are distinct from mammogram findings of breast cancer. A radiologist presented the radiologic literature relative to fat grafting and concluded that any skilled radiologist can tell the difference between post fat grafting mammographic changes and breast cancer.
Proper Patient Selection
These leaders discussed the importance of choosing appropriate patients and thorough informed consent before surgery. The patients who benefited the most from fat grafting from their experience were mastopexy patients, implant failure, breast reconstruction, and primary augmentation patients. We discussed the different fat grafting techniques for each of these patients an how to maximize graft survival through proper harvesting, processing and injection of fat with standardized techniques.
Each international expert stressed the importance of discussing with patients that this is new technology and is still experimental in nature. Patients in Minneapolis need to know the process, risks, benefits and the possibility of future scientific findings relative to this procedure. Risks discussed included incomplete fat graft survival with an average of 50% graft take, the need for re-grafting and donor site morbidity, cyst formation, fat necrosis with calcification, as well as permanent mammographic changes to the breast. They discussed that patients should understand this is a staged procedure with additional costs and that fat is living tissue and will change with changes in body weight gain or loss. There was also discussion about the role of stem cells in grafted fat.
Fat grafting is not for everyone and is being used for reconstructive and aesthetic purposes throughout the world. The future is now in Minneapolis.