Augmentation mammoplasty by lipofilling (fat injection)

Fat injection in the breasts will give a natural volume without implants and without foreign matter, the fat of patient being injected.

This technique allows a more moderate increase of the volume of the breasts: about 30% of the injected fat systematically resorbs. Usually, mammary lipofilling can create a volume augmentation corresponding to a 200 – 250 cc implant (maximum), between one and two cups. A second operation can be carried out for a more important volume or to create a result similar to larger implants.

Lipofilling is advised for the following:

• Moderated mammar hypotrophy (due to genetics, pregnancy, breast feeding, weight loss...).
• Moderated mammar asymmetry which may imply the reduction of a too large and sagging contralateral breast.
• Associated with a mammar augmentation with implants for thin patients, to avoid the lines of the implants to be visible.
• Enhance breast lines for patients with implants (folds reduction, shape enhancement...).

Criteria for a mammar augmentation by fat injection

In France, the authority of the French Society of Plastic Reconstructive and Aesthetic surgery
(Société Française de Chirurgie Plastique Reconstructrice et Esthétique - SOFCPRE) established specific criteria for this procedure. They correspond to the low risk of coincidence with breast cancer:

• Women under 35 without personal or family history of breast cancer.
• Preoperative radiological evaluation (mammography, echography) carried out by a trained radiologist is deemed to be indispensable and its normality (ACR1 or ACR2) is the essential prerequisite to the fulfilment of the procedure.
• The SOFCPRE advises a reference radiological evaluation one year after the surgery, if possible with the same radiologist, and a regular medical supervision.

Before the procedure

Two consultations with your plastic surgeon with at least 15 days between each are mandatory before the operation. Medical photographies are always taken during these consultations. There is a systematic clinical examination in the surgery with a palpation of the breasts to ensure there are no anomalies and with a discussion to ensure there is no history of breast cancer in the patient's family.

Radiological evaluation of the breasts is mandatory: mammography, echography and possibly an MRI. This evaluation is mandatory, breasts need to be strictly normal for a lipofilling.

Stop smoking 1 month before the surgery to improve fat graft take with a better vascularisation of the breasts. No aspirin-based, anti-inflammatory medication or oral anticoagulants should be taken during the 15 days preceding the operation to reduce the risk of bleeding. No oral contraception 1 month before the operation to reduce the thrombo-embolic risks. Avoid pregnancies during 6 months after the surgery to preserve the result of the procedure.

The procedure

The operation is carried out under general anaesthesia.

Fat tissues are extracted with a thin suction cannula. A micro-incision is made in the natural folds of a discrete area with some fat tissues or with an excess of tissues.

The extracted fat is centrifuged a few minutes before being injected. This way, intact fat cells that will be transplanted are separated from other elements (blood, oil...).

Reinjection of fat tissues is made through 1 to 2 mm incisions in the under-breast fold.

Fat is injected with very thin cannulas in different layers to increase the contact surface between the grafts transplanted in the breast and the receiving tissues. Fat cells will benefit a better vascularization and the result will be more stable.

Fat is injected in the gland and under the skin, between the gland and the greater pectoral muscle, in the greater pectoral muscle and between the muscle and the rib bones.

After the procedure

Hospital stay is short, the patient leaves on the same day in an ambulatory facility or the next day.
Pain is moderated and is more important in the treated areas but they are well balanced by the usual pain-killers. Bruising is frequent after surgery, especially in the areas of extraction. They remain visible during 15 days.

Swelling in the areas of extraction and on the breasts disappears between 1 and 3 months after surgery. The patient accepts an annual regular clinical and radiological follow-up.
 

The result can be truly seen from 4 to 6 months after surgery, once the fat that did not integrate has resorbed.

If resorption is important (it varies from one patient to another) or if the patient expects more volume, a second operation can be carried out about 6 months after the first one.

The result is final after 6 months. Usually it is very satisfying, with the volume increased and the shape of the breasts enhanced.

However, fat has a genetic memory and when the patient gains or loses weight, breast volume varies in the same way.