March
2009
Fat Grafting to the Breast Has New Guiding Principles15
In a new statement by ASPS entitled Fat Transfer/Fat Graft and Fat Injection ASPS Guiding Principles, fat grafting to the breast has been cautiously approved by the ASPS for use in breast reconstruction, breast shaping and breast augmentation.
Before (left) and 8 years 9 months after one fat grafting procedure of 332 ml to the right and 297 ml to the left. Patient had 10 pound weight loss between procedures
After ten years of experience with fat grafting to the breast using his specific technique, Dr. Sydney Coleman began presenting his results at plastic surgery meetings in 2005. Perhaps the most pivotal presentation by Dr. Coleman was in 2006 at the American Association of Plastic Surgery. His impressive long-term results resulted in an active discussion in the Plastic Surgery world on the use of fat grafting in the breast.
The American Society of Plastic Surgery had previously directed plastic surgeons to avoid placing fat in the breast due to safety and outcome issues. Dr. Coleman and others demonstrated that the original concerns were not based in any scientific evidence, and instead the evidence was in support of fat grafting to the breast.
As a result of Dr. Coleman’s many presentations, he was able to persuade Roxanne Guy, then president of the American Society of Plastic Surgery, to form a task force of plastic surgeons to revisit the issue of fat grafting to the breast. The task force began meeting in September 2007. “The task force reviewed the scientific literature, critically appraised the information available, and developed evidence based practice recommendations. The findings of the task force were then submitted to an approved without significant change by the American Society of Plastic Surgery and the Plastic Surgery Educational Foundation executive committees.
The recommendations indicated that “Fat Grafting may be considered for breast augmentation and correction of defects associated with medical conditions and previous breast surgeries.” The society also indicated that people should proceed cautiously because “results are dependent on technique and surgical expertise” as in every other surgical procedure.
Subsequent posts over the next few days will address the other findings of the American Society of Plastic Surgery’s task force on fat grafting to the breast. Stay Tuned!
Before (left) and seven years after (right) one fat placement of 190 ml on the right side and 245 ml on the left. Note the filling of the "cleavage" area and the very natural appearance (and feel) of the breast
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
For information on the consultation, procedure and pricing for Dr. Coleman’s fat grafting to the breast CLICK HERE.
Check out these links more information on fat grafting to the breasts:
Dr. Sydney Coleman demonstrates Breast Reconstruction with LipoStructure on The Doctors
Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons
Lipofilling: a role in breast reconstruction surgery??From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting?From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.?Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.?Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
Dr. Coleman, How much fat is needed from donor sites to make a 1 cup enlargement? I am a 105 pound 24-year old, looking to go from an A to a B cup. Also, do you have any recommendations for surgeons on the west coast that have a lot of experience with this procedure? Although I would love to see you, I live in California.
Stephanie,
You would need a minimum of 200 cc of refined fat on each side, and if you have 300 cc it would be better. There are ways to push the size up higher which I have been using that look quite successful. Although I have been grafting fat to the breast since 1995, most plastic surgeons have not been successfully grafting fat for more than a few months to the breast. I have not see enough results and followup of anyone in California yet to be able to recommend them.
Be careful, because the last thing you want to do is deplete your harvest sites with an unsuccessful attempt at breast enlargement with fat grafting.
Dr. Coleman,
I am so excited to find out that fat grafting for breast augmentation is possible with your technique! I am barely an AA cup and would LOVE to be a full A or even B if that would be possible.
1) I am 20 yrs old, 5’6” and 125 lbs., BMI 20.2. Do I sound like a good candidate, i.e., enough fat?
2) With your technique, what is the average fat survival rate? I have heard everything from 50-90%.
3) Do you have your patients use a suction bra before and/or after the procedure? I didn’t see any mention of this on your website so don’t know if you use this method or what you think of it.
4) I read that the clinic in Japan injects fat that is highly concentrated in stem cells. I understand that you use refined fat, but I’m not clear on the stem cell concentration. Is your method similar to this or do you use fewer stem cells?
I would greatly appreciate your answers! I’m strongly considering coming to you for this procedure if you think I’m a candidate. Thank you so much!
Karen,
You sound like a great candidate for a combination of a suction bra to expand your chest before placing fat and using my technique of refined, concentrated fat. The suction bra (Brava) can expand your breasts initially to give me more room to place the fat, and I think there is great benefit for using it after the procedure also.
If you have not already had liposuction, you probably have enough fat in your lovehandles and/or thighs.
The survival measured in animal studies using my technique can be as high as 80%. We have not developed a great way to measure survival in humans after fat transplantation, but in a young woman it should be relatively high.
The clinic in Japan is doing interesting manipulation with stem cells, but the important factor is that stem cells are in fat normally. The number of stem cells does not increase by the Japanese method; it is just distributed differently in the fat.
I do something simpler but perhaps even more effective for concentrating the stem cells and perhaps more importantly concentrating the growth factors. This promotes more reliable take of the transplanted fat tissue.
If you have any more questions, please contact my office.
SRC
Thank you for your response! I talked to Renee and am making plans for a consultation with you in August with the surgery sometime in September. I’ve actually been wearing Brava for 2 weeks and I was wondering if you would recommend that I just keep wearing it until the procedure. Depending on when it’s scheduled, I will have been wearing Brava for about 8-11 weeks.
Also, I wear it for about 15-17 hours daily and use a little extra suction than what the smartbox normally gives because other ladies have said that they feel the long hours and extra suction gives better results (it definitely gives me better swelling). I’m just wondering if there could be any danger of damaging my cells for this procedure by doing what I’m doing- maybe I should just use the smartbox level of suction in preparation? Or maybe it doesn’t make a difference and I can keep up my little routine? Thanks so much!!
Karen,
You are on the right track. Keep wearing the Brava daily. To make it more comfortable, I would use a lower suction and maybe even reduce the hours for now. The last thing I want is for you to burn out on the Brava before the crucial time, the two or three weeks before your procedure.
When you are close to your procedure, then you can increase the vacuum and length of time that you are wearing the Brava. There is no evidence that you will do any harm to your breast or fatty tissue on the higher settings if you can tolerate them. However, occasionally women have experienced skin problems (rashes, et cetera), especially on the higher suction.
If you do have any problems with the Brava, please contact us and we can put you in contact with a Brava coach who can advise you.
SRC
Doctor:
I suffered by tubular breast and tried every method to increase the size but none of them works. I was thinking of implant but afraid of the fake look and touch. I am thinking of doing fat injection to correct my tubular breast. A lot of doctors argued that the fat injection doesn’t work in tubular breast since it is impossible to expand the base and it might just make the situation worse. I would like to know your method. And also in Japan, that clinic is using PRP+ stem cell. Do u do the same?
Best Regards
Mia
Mia,
I use a combination of my structural fat grafting technique with the Brava system to help reconstruct tuberous breasts. Please refer to my recent post on tubular breasts (see link below). I usually do not release any adhesions on the lower pole, and have so far been able to consistently expand the lower pole.
I do concentrate the stem cells, but in a way different than Cellport. This allows me to control the placement of stem cells.
Please call my office at 212 571 5200 and speak with Renee for more information.
SRC
http://www.drscoleman.net/2009/09/dr-sydney-coleman-of-new-york-city-combines-the-brava-system-with-breast-lipostructure/
Dr. Coleman,
I understand that there are not extensive studies on the survival rate of fat transplanted into the breast. I would imagine that many individual factors would affect that outcome. I also understand that the procedure itself and doctor’s technique has great bearing on the outcome.
My question to you is… after having done the amount of transfers you have, do you see any correlation between aftercare methods and successful retention of transplanted fat? Do you believe in the effectiveness of (or been witness to) results from using hyperbaric oxygen therapy or any other methods? How about supplements?
It would be incredibly disappointing to go through a 4-6 hour procedure, a good deal of money and end up reabsorbing all the fat that was transplanted! As patients, what can we do to make the most out of a surgery like this?
Your advice and expertise is much appreciated.
Thank you.
Dr. Coleman,
I was 20 yrs old when I had my breast augmentation procedure. I went from a normal B cup to A small D. I will be 30 yrs old next year and realize that big breast is not my idea of beauty hence will like to have them removed. Understanding that the skin elasticity will not retract the sagging skin to its original condition, I am contemplating lipostructure to fill in. ALthough, I do not want to go back to a D cup but perhaps a small C, what are your recommendations. Also, will the fat melt is I start working out more intensely than I am now.
Further, I am anticipating pregnancy with 2-3 yrs, would it be better to do it before of after the breast swell due to pregnancy?
Nia B.
Nia,
The greatest strength of LipoStructure® is that it allows me to work with you to design the shape of a breast. I would need to examine your breasts, but there is a good chance that you may be able to remove your current breast implants and restore/reshape your breasts to an attractive “C” cup without a breast lift (mastopexy). If you call my office and speak with Renee (+1 212 571 5200), she can arrange a consultation either in New York or long distance in which you would send photographs.
I would recommend that you remove your implants before pregnancy. With such large implants already in place, the growth of your breast with pregnancy would significantly stretch the skin of your breast. This will create more stretch marks and less elastic skin.
By the way, placement of stem-cell rich fat next to breast skin can help diminish stretch marks!
SRC
Roxanne,
Recent laboratory studies have indicated that using the LipoStructure® technique concentrated fat can survive up to 85 or 90%. The same and similar studies have shown that altering the technique can result in much less survival.
There are many steps in the process of transplanting living fat, and the fragile tissue can be injured or wounded easily during the harvesting portion, during the refinement and concentrating phase and even during the placement phase. In addition, if living fat is not placed into the body under ideal circumstances, then it may not have enough access to a blood supply and will die.
I have been transplanting fat to the breast since 1995. Even though I had great success in the very first cases I performed, I have been working to improve not only the survival of the fat but also the effect of the fat on surrounding tissues, especially the skin. These improvements involve the technique and external expansion. I do not believe that hyperbaric oxygen therapy would be worth the bother, although it would be interesting for someone to do a study on its use in fat grafting (none exist to my knowledge).
To make the most out of any procedure in medicine, you should go to someone who has a lot of experience in the procedure and who can demonstrate to you the result that you desire to attain. The patient should be aware how long the surgeon has been doing the procedure, and see the surgeon’s long term follow-up if there is any. Be aware, that I have discovered several physicians using photographs from my books and publications and claiming that they are their patients.
There are no guarantees in medicine since we are complex biological organism, but certain maneuvers can maximize the potential positive outcome in any procedure.
Please call Renee in my office +1 212 571 5200, to discuss any further questions you might have or to arrange a consultation either in New York or long-distance.
SRC
ok, what are the possibility of this fat to melt away? ca we squeeze the breast (not exessively but like playfully) without the fat to deplete the breast pocket?
I am not a really big girl hence dont have much fat around me. Also, I had a row on my lower stomach that was bothering and had it liposuctioned. The surgeon was able to get only 300cc of fat all together, when I complained that I thought I still had fat he told me that it was fibrous tissue (or scar tissue) as Im sure you are familiar. There is no fat left to remove. I really want to remove the implants, I dont want to have a lift or any other type of cutting implants within me, and I dont want to have empty pockets where the implants are located.
I think my bags are in the 300cc marks (give or take),I dont want to go that big again, although im 5′7, i just want natural breast.
Is that too much?
Nia B.
Nia,
I have had great success with the long-term results with many patients. However, every patient is different from the next and you may be an ideal candidate or you may not be.
It is difficult assessing your situation without examining you. I need to examine the envelope of your breasts, test how elastic your skin is, measure the fat and breast tissue currently in your breast, and the determine the amount of fatty tissue present in other areas of your body.
Please take the time to schedule a consultation. As I mentioned before, call my office they can help you with more answers.
SRC
Dr. Coleman,
Thank you for your thoughtful and informative response. Everything you explained seems logical..and it will be very interesting to see what other studies are created as a result of this amazing technology. I will continue to keep my eyes and ears open.
All the best,
Roxanne