Fat grafting to the breast

Recently, there has been a resurgence of interest in the idea of using a person's own fatty tissue to enhance the breast. It seems like the ideal combination: "take a little off there, and put a little bit more up here".

The truth is: it's still a work-in-progress. Until recently, fat grafting to the breast had been considered a bad idea. Lumpy breasts, with oil-filled cysts, could occur. And worse, the scar tissue which sometimes formed after fat injections could exactly mimic the appearance of a breast cancer on a mammogram, leading to needless anxiety and additional biopsies.

Lately though, there has been a re-appraisal of this idea, both here in the USA and abroad. A breakthrough study from Japan found that the key factor to making the fat injections work in the breast seems to be the addition of stem cells.

By "turbo-charging" the injected fat with the person's own adult stem cells (also found in fatty tissue), the combination of fat cells and stem cells worked much better, successfully surviving the move from the donor site to the new location in the breast without the problems listed earlier.

Some pretty clever machinery is used to harvest, centrifuge, and purify the stem cells from liposuctioned fat. Some far-sighted biotech companies have already submitted automated versions of this machinery for FDA approval.

The Japanese group made fairly modest changes in the patient's breast size - averaging about 200 cc, which is small compared to the typical breast implants that we use here (commonly 300 - 500 cc), but their results show that the technique is promising. The fat-grafting surgery also takes much longer than a typical breast augmentation: about 6 hours of anesthesia time, compared to about 1 hour when implants are used.

Nevertheless, it's an exciting surgical innovation that someday (I hope) will be in common use. Currently, the technique is not FDA-approved, and is still in the "experimental" stage.

Lipodissolve & Mesotherapy: the low-down

Here's a hot topic: can you melt fat by injecting certain active substances into it, and is this safe to do? Those are the key questions to be determined when in comes to injection lipolysis, also known as Lipodissolve, Flab-jab, and a number of other proprietary names.

Currently, the two most commonly used drugs, the soybean-derived phosphatidylcholine (PC) and a bile-salt derivative called deoxycholate (DC), are not FDA-approved for this purpose. These are injected, sometimes with a cocktail of other ingredients, into the fat, using a grid-like pattern. This is typically repeated at intervals, until the desired results are seen, or the patient gives up, or runs out of money!

While this procedure is poorly-understood and needs a whole lot more research to determine the best way to do it, here's what we do know from the scientific studies:

1) The injections don't "melt" fat - they cause the fat cells to rupture, killing the fat, which is then replaced by scar tissue;
2) The DC seems to be more effective in causing the effect, compared to the PC;
3) Some studies have found no benefit whatsoever; others have seen a measurable effect, with a reduction in fat;
4) We don't really know the optimal dosage and mix of ingredients;
5) We don't know where the "melted" fat goes, and whether this process has side effects;
5) Some people have reactions to the injections, with pain, swelling and lumpiness. Fortunately, most of these reactions are usually transient;
6) Some people have no response to the treatment, other than the inevitable thinning of their wallet. These people usually come to me later, for actual liposuction.

So far, I feel that injection lipolysis should be classified as an experimental procedure. Although I'm very interested in it, I don't offer it to my patients. I feel that the details really need to be worked out first. Liposuction is still the undisputed standard for fat removal.

Regulatory approval would also help me feel better about this technique. When the FDA, Health Canada, the UK's Medicines and Healthcare Products Regulatory Agency (MHRA), and the Brazilian version of the FDA all speak out against this procedure, that should tell you something. It's probably not "ready for prime time" yet.

The research wing of ASAPS (American Society for Aesthetic Plastic Surgery) has a study going on this right now. I'll post the results as soon as they are available. Personally, I'd like for this technique to work - it would add another useful method to those we use currently, and would be minimally-invasive, as well. We'll have to wait and see...