Autologous fat transfer: an alternative to breast implants
UNO spoke to Paul Salmon, surgeon at The Skin Centre about the method of using your own body fat to increase your breast size, as an alternative to breast implants.
UNO: Can you tell us about autologous fat transfer and breast surgery?
Paul: Autologous fat transfer or AFT is a technique of restoring or enlarging the breast by grafting fat into it. People have been trying to put fat into breasts for many years, but with haphazard results for a number of reasons. First, there isn’t enough space in a small breast. Also, the fat is put into the breast in large lumps, which doesn’t make for a successful graft. Recently, there has been a lot of interest in preparing the breast by expanding it slowly over the weeks prior to grafting. This technique has revolutionised AFT by providing the right environment for the reliable take of grafts.
UNO: How long have you been doing this procedure?
P: I have been grafting fat and doing liposuction for breast reduction for 25 years. Liposuction of the breast is really the reverse of AFT; women can get rid of overly heavy breasts without scarring and still have confidence in being able to breastfeed later. In 2017 I went to Florida to operate with Dr Khouri, who had published the seminal papers on Brava, a breast expansion device, and AFT. Since then, I have been doing the procedure both in Tauranga and Auckland.
UNO: How does the process work?
P: AFT involves a gentle liposuction of fat from an area where it isn’t wanted. It’s then prepared and grafted into the breast. Prior to the procedure, the patient spends a few weeks using an external expander, usually at night. Used regularly, the small suction dome will enlarge the breasts. If the expansion is stopped, the breast will shrink again. It’s the grafting of fat that makes the enlargement from external expansion permanent. The grafted fat is laid down in a 3D network of tiny, thin strips in the breast, eventually building up the volume for a larger breast. There are virtually no scars, as only tiny nicks of 2mm in length are needed to allow us to insert the fat into the breast.
“One thing to think about is that because your breasts have been enlarged by fat
transfer, if you gain or lose weight, your breasts will respond accordingly.”
What are the benefits of AFT versus breast implants?
P: Implanting breasts with silicone prostheses is very safe. As with all procedures and general anaesthetics, complications are a risk; infection, bleeding, loss of sensation, scarring, the wrong placement or rupture of an implant or capsule formation are the most common complications. Cancer is a very rare complication. AFT gives a woman the opportunity to have larger, younger-looking breasts naturally without synthetic implants. And there’s an opportunity to get better-looking hips, legs or tummy, depending on where the fat is taken from.
UNO: What are the disadvantages of AFT?
P: To work reliably, the breasts must be prepared by using the external expander every night. The most popular size for silicone implants in New Zealand is around 300ml, which is more than a AFT procedure can reliably produce. With AFT, women can expect to go up one cup size, although further increases can be achieved with an additional AFT procedure. Also the fat placed into the breasts is treated by the body as if it is still in its original position, so if your graft fat comes from your tummy and you put on weight there, your breasts may also enlarge.
So this technique be used to reduce breast size?
P: Yes, we can use the liposculpture technique on its own (without using the expanders). This will reduce the size of overly large breasts. Tiny incisions around the edge of the breast mean that excess fat can be carefully removed to maintain the same shape of the original breast.
MEET THE SURGEON
Dr Paul Salmon Paul is New Zealand’s most published dermatologic surgeon with over 60 papers published in peer-reviewed literature. He has an Honorary Fellowship in the Australasian College of Dermatology, and has been a speaker at the World Congress of Dermatology as well as the American College of Mohs Surgery. He has served on the Specialist Advisory Committee for the RACP on behalf of the NZDSI. His areas of special interest are cutaneous oncology, micrographic surgery, prevention of skin cancer, sun damage and cosmetic surgery.
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