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Tuesday, December 21. 2010

Can fat transfer be used to make breasts larger? Is it safe?

I believe the question is not "If it is possible?"

The question should be: Is it safe?

I performed several breast augmentaions with autologous fat during my fellowship in 2000 (BAMBI). 

I then learned from Dr. Mel Shiffman and others that the transfered fat can rarely become calcified. The calcification itself is not an issue as it is microscopic but it MAY mask an underlying breast cancer. Five to seven percent of American women develop breast cancer during their lifetime.

I hope that we can develop better modalities to distinguish calcification from fat transfer to the breast from the malignant calcification that is sometimes seen in breast cancer. Until then I recommend to proceed with caution.

Below is an update on fat transfer to the breast by one of the leading doctors in the field:

Update on Cell-Assisted Lipotransfer

by Jeffrey Frentzen

Kotaro Yoshimura, MD


Yoshimura is an assistant professor at the Department of Plastic Surgery in the University of Tokyo.

Highlights of this procedure include the following:

  • The patient is under general anesthesia. A saline solution containing a weak local anesthetic and a vasoconstrictor is injected into the areas where fat is to be suctioned. This softens the treated area and constricts the blood vessels.
  • Via a tiny incision in the skin, a narrow metallic tube is inserted and a liposuction pump is used to suction subcutaneous fat.
  • Mild swelling and pain that occurs on the suctioned area or the injected area goes away in around 1 month.

I spoke with Yoshimura to get an update on the status of CAL in Japan and to find out if his procedure would be imported to the United States anytime soon.

Yoshimura: More than 400 patients have been done by the end of 2009. Overall results are satisfactory and encouraging so far. Although clinical outcomes are very variable among patients and many factors—including operator factors and patients' factors—affect clinical outcomes, quality and naturalness of augmented tissue is excellent. Preserved tissue volume appeared to be much better than conventional methods.

PSP: What are the differentiating age/race/gender/demographics of the patients? What percentage received each procedure according to breast, face, hip, etc?

Yoshimura: The frequent age is between 30 to 50 years old, almost all are Japanese, and all are female other than four males. The procedures break down as 83% breast (55% augmentation, 15% implant replacement, and 13% reconstruction), 15% face, and 2% others. But there have been many breast reconstructions and facial reconstructions. Among the latter are acquired defects, Parry-Romberg disease, Lupus erythematosus, scleroderma, etc.

PSP: What were some outstanding characteristics of the patients treated in the breast? The patients treated in the face and on the hip?

Yoshimura: Natural contour and texture, softness, absence of artificial material, free of complications associated with implants, free of future risks for additional surgery, free of daily stress from implants.

Since 2008, there has been some new literature published about this procedure. See list below.

Suga H, Araki J, Aoi N, Kato H, Higashino T, Yoshimura K. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol. 2009;36:1293-1298.

Suga H, Eto H, Inoue K, et al. Cellular and molecular features of lipoma tissue: comparison with normal adipose tissue. Br J Dermatol. 2009;161:819-825.


Yoshimura K, Asano Y, Aoi N, et al. Progenitor-enriched adipose tissue transplantation as rescue for breast implant complications, Breast J. 2009;DOI: 10.1111/j.1524-4741.00873.x



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