Autologous Fat Transfer for Breast Augmentation

The following consumer summary is provided by the Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), a programme of the Royal Australasian College of Surgeons (RACS).

Autologous fat transfer for breast augmentation is a surgical technique that has been developed to increase the size of the female breast.

Fat cells taken from elsewhere in a patient’s own body are called autologous fat. To enlarge the breast, fat cells from, for example, the thigh, are sucked out of the body using liposuction and injected into the breast. Only very small quantities are transplanted at a time because the fat cells need to develop their own blood supply or they will die.

There is not enough evidence to compare the safety and effectiveness of this procedure with the more conventional techniques of breast implantation using breast implants.

Although breast implants seemed to be associated with a higher overall rate of complications than the newer procedure, the numbers of autologous fat transfer patients were too low for a true comparison to be made.

The complications reported included the following:

• Calcification (calcium build-up in tissues) of fat droplets is the most common complication (1.4–15% of cases). This may give false positives for breast cancer under mammography, leading to more biopsies.
• Infections may occur (up to 10.5% of cases).

Large sacs of dead tissue (necrotic cysts) can form which must be removed by reoperation and a saline or other prosthetic implant may be needed to restore the original shape of the breast.

Only a small increase in breast size is theoretically possible using this technique (no more than one bra cup size). From 30 to 400ml of liposuctioned fat has been injected in stages into the female breast, sometimes over a period of months. If injected fat is reabsorbed by the tissues, however, it no longer acts to enlarge the breast. Rates of fat reabsorption ranged in different case series from less than 20% after 1 year with breast enlargement maintained by fibrous tissue, to 100% reabsorption (and hence no increase in breast size) after 12 months. In this latter case the operation was found to be completely ineffective.

Not enough evidence was available on patient satisfaction following this operation.

There is too little data available to decide whether autologous fat transfer for enlargement of the breast is as safe or effective as the conventional techniques of saline and cohesive silicone gel implants; certainly larger increases in breast size could only be achieved with prosthetic implants.

The masking of breast cancer after the newer procedure due to calcification of fat droplets is of major concern, but implants can also affect mammography by blocking breast tissue from imaging.

It is also unclear if autologous fat transfer does what it sets out to do, namely enlarge the breast, as the fat droplets can be reabsorbed by the breast tissue and the small amount of published evidence is contradictory. For these reasons the Royal Australasian College of Surgeons could not endorse the collection of data within Australia for this procedure.