Breast fat transfer in Tunisia

What is breast fat transfer?

Breast fat grafting also called breast autologous fat transfer  is a surgical technique for breast augmentation that allows the collection of own fat in a body area (saddlebags, abdomen, flanks ...) through liposuction, then reinject it to (re) give volume to your breasts.

Indications for breast fat transfer

Above all, we must understand that breast augmentation by lipofilling, cannot replace in any case all indications of breast augmentation with implants.

The aesthetic breast augmentation by fat injection has its best indications in women:

• Who have moderate breast hypotrophy.
• Who does not want a foreign body (implant or breast prosthesis).
• Who have a localized excess fat (saddlebags, abdomen, flanks).
• Who want moderate breast augmentation.

The SOFCPRE (French Society of Plastic Reconstructive and Aesthetic Surgery) currently recommends limiting the technical aesthetic breast augmentation to women less than 35 years with no personal or family history of breast cancer.

Breast fat transfer limits

• Injection of fat in the breast allows moderate breast augmentation breast volume, due to the systematic elimination of part of the injected fat (30 to 40%). Breast lipofilling allows an increase equivalent in volume of breasts breast prosthesis 200-250 cc maximum, between 1 and 2 cups.
• This technique is possible only if the patient has a sufficient fat donor site.
• This technique is prohibited in patients with a known, personal or family history of breast cancer.

Breast augmentation with prostheses or implants far remains the treatment of choice for cosmetic breast augmentation, especially if the patient desires a significant increase in the volume of her breasts.

A second operation, 6 months to 1 year later, could then afford to get a greater volume similar to breast implants.

Breast fat transfer benefits compared to breast implants

• Absence of risks related to breast implants: hull rupture prosthesis, waves or folds...
• Refinement of the silhouette with liposuction of donor areas.
• No risk of rejection of the injected fat: the fat from the patient's own body.
• Absence of scar (just the micro-incisions scars).
• Consistency very natural to touch the breast.
• Very natural appearance of the breast.

Breast fat grafting disadvantages

• Ability to make only a moderate breast augmentation.
• Possibility to make one session lipofilling breast if the donor areas do not allow a second session.
• Asymmetric fat resorption Risk of breast to another, which may give an unbalanced result and requiring retouching.
• Risk of bad "engraftment", resulting in fat necrosis with nodules of "fat necrosis", usually spontaneous resorption or causing their surgical removal.
• Risk of oil cysts, which may lead to their surgical removal.
• Appearance of calcifications on mammography (tissue scarring), which can be confusing with breast cancer so inexperienced radiologist.
• The patient must be prepared to a second operation 6 months to 1 year later to create more volume.

You should know that "too much fat injected immediately" increases the risk of necrosis and oil cyst, but also unnecessarily consumes fat reserve of the patient.

Before breast fat grafting surgery

• A preoperative blood test is required
• Preoperative radiological assessment (ultrasound and mammography) is required, and its normality (or RCA1 ACR2) is indispensable to the realization of this technique.
• Medical guidelines to follow are:
  • Stop taking aspirin, anti-inflammatory drugs, or oral anticoagulants 15 days before surgery.
  • stop oral contraceptives (pills) one month before the procedure.
  • Avoid pregnancy in the year following the intervention.

This is a conventional general anesthesia.

The intervention requires 1-2 nights’ postoperative hospitalization (depending on the amount of fat removed).

Breast fat transfer procedure

• 1st time: Collection of fat by liposuction:
  • The selection of sampling areas of fat depends on donor sites available, the amount deemed necessary fat and desires of the patient.
  • This is a real liposuction performed in the most atraumatic as possible, with small incisions hidden in the natural folds using a thin suction cannula.
• 2nd time: Treatment of fat by centrifugation: centrifuge fat to separate intact fat cells, which are grafted, elements that are not transplantable (oil, serum).
• 3rd time: Breast augmentation by injection of fat:
  • Transfer of fat cells occurs through micro-incisions of 1 to 2 mm.
  • The fat is then injected using thin cannulas in different planes (the pectoral muscle to the skin) and according to several paths to allow to increase the area of contact between the transplanted cells, and thereby a best "engraftment".
  • The injected volume is variable depending on the amount of fat available and desires (100 to 300cc or more).

Usual post operative after breast fat grafting

• Moderate pain the first few days at the most important areas sucked. Analgesic treatment will be prescribed.
• The edema (swelling) put 1-3 months to subside.
• The bruising (bruises) are resorbed within 10-20 days.
• A fatigue.
• A bra without underwire must be worn day and night for six weeks.
• A compression sleeve must be worn day and night for six weeks after liposuction.
• The work stop time is from 8 to about 12 days.
• The resumption of sporting activities is authorized from the 2nd month.
• The final result (volume and shape of the breasts) is observed after 3-6 months.

Breast fat transfer results

The end result is observed between 4 to 6 months. It is usually very satisfactory: moderate breast augmentation and improved silhouette.

A second session is possible lipomodelling breast after 6 months to 1 year if the patient wants more volume, and if the donor areas of fat permit.

The engraftment is estimated at 60-70% depending on the patients. There is therefore a fat absorption of 30 to 40%.

Cosmetic breast lipostructure is a definitive method: the cells grafted remain alive.

However, you should know that fat cells have a genetic memory: when the patient grows or loses weight, breast size varies in the same way.

Breast fat transfer conditions

In France and since November 2011, the French Society of Plastic Reconstructive and Aesthetic Surgery (SOFCPRE) set specific criteria to allow breast augmentation by lipofilling:

• Under 35 years old woman with no personal or family history of breast cancer
• Preoperative radiological assessment (ultrasound and mammography) is required, and its normality (or RCA1 ACR2) is indispensable to the realization of this technique.
• The patient is committed to making a reference imaging assessment one year after the intervention (by the same radiologist preferably) and to remain under regular medical supervision.

Breast fat transfer risks

Complications of breast augmentation surgery by fat injection are fortunately very rare.

• The thromboembolic events (phlebitis, pulmonary embolism).
• The infection is exceptional.
• A pneumothorax pleural breach is rare but possible.

• Cystostéatonécrose by bad "engraftment".
• Oily cysts.
• Result Imperfections: asymmetry, excessive resorption, insufficient volume, irregularities.
• At the level of sampling areas: all risks of liposuction.

In all, one should not overstate the risks, but just be aware that surgery, even seemingly simple, always has a small share of hazards.