By the way that many “cosmetic surgeons” have recently been touting the use of fat grafting to augment breasts, one might think we have blindly wondered into Shangri La!

“No silicone!”

“No implants!”

“No risk!”

But the reality is “No science!”

The existing scientific evidence to support the long-term safety and efficacy of fat grafting the breast is shockingly wanting. While some nicely done studies have been done to support short-term results, the cosmetic surgery community has rushed to implementing this procedure into their practices way before the appropriately designed and completed scientific studies have been done. Many of the existing studies have been done only with laboratory, non-mammalian animal models.

Well-done studies on human subjects are ongoing but it will take years and years to be able to follow these patients long term and establish the legitimacy of the fat transfer breast augmentation. Some of the longer-term studies have been done outside the United States and have yet to be replicated by our own board certified plastic surgery community. Also, the majority of quality studies existing relate to reconstructive breast patients (i.e., breast cancer reconstruction patients) and not to cosmetic elective surgery patients, where the majority of procedures seem to be occurring.

So, what are the risks? Why be concerned?

While many of the early skeptics rightly pointed to the possibility of breast fat injections causing difficult-to-read mammograms, most well done studies show that these concerns are probably unfounded. Radiologists seem to have little difficulty reading mammograms in patients having undergone fat grafting to the breasts.

We do know that fat grafting of the breast has limits and that multiple lengthy surgeries may be required to achieve significant breast enlargement as opposed to a single surgery for breast augmentation with an implant.

The bigger concerns center around whether fat grafting to the breast can possibly be associated with a higher risk of developing breast cancer or even accelerating the growth of a previously undetected breast cancer. Recent rodent model studies seem to prove this to be true, while one international human model study did not show this problem. The concern likely has to do with the ever-popular notion of stem cells.

Stem cells are being recognized as possibly having rejuvenatory properties on human skin. For instance, plastic surgeons who perform fat grafting to the face, as an alternative to a facelift, have noted that the overlying skin seems to look younger and fresher post-operatively. These clinicians are convinced, and may be correct, that stem cells are responsible for this phenomenon. And stem cells have been proven to be in the fat used during fat grafting procedures. So, if these fat grafting procedures are transferring rejuvenatory cells into the areas being grafted, what effect might these same stem cells have on breast tissue which has an extremely high risk of cancerous degeneration already? If a stem cell can “rev up” your skin, will it also “rev up” a breast cancer?

My personal philosophy for fat grafting of the breast is one of patient safety first. Until we have more science to show the long-term safety of this procedure for my Atlanta area plastic surgery patients, I will not offer it or any other poorly understood procedure for a female organ that is already cancer prone. While I do hope that well-done long-term studies show this to be a good and safe option for patients, I do not encourage patients to opt for this procedure at present. Avoid the search for Shangri La. The bite may well be worse that it’s bark!

If you are interested in breast surgery and would like to learn more about a options available for you, contact my Atlanta area practice today to schedule a consultation with me, a Board Certified Plastic Surgeon.

October has traditionally been designated Breast Cancer Awareness Month since 1985. As breast cancer has taken a position in the media spotlight, it is crucial that we familiarize ourselves with how to prevent and detect early signs of possible breast cancer. Please contact your primary care physician to answer any questions you may have about when and what type of breast cancer screening may be appropriate for you or your loved ones.