Lipofilling -fat transfer breast augmentation

Breast lipofilling (also known as breast lipo modelling), i.e. breast enlargement of the own body fat graft, is a relatively new procedure in aesthetic surgery and was initially used in oncological patients for post-mastectomy breast reconstruction, or in patients with congenital malformations (e.g. Poland's team, where we deal with, among others, unilateral hypoplasia of the breast). The very idea of ​​lipofilling in aesthetic medicine was already present - with the improvement of the contour of the red lip or even filling the cheeks.

Breast lipofilling - characteristics

The lipofilling treatment will be suitable for women who want to subtly compensate for the asymmetry of the bust, improve its firmness and filling or return to its shape before breastfeeding or losing weight. Although without any doubt you can achieve a satisfactory and above all a natural effect, you should know that you cannot put an equal sign between breast lipofilling and breast enlargement with silicone implants. With the use of implants, you can enlarge the breasts properly by any number of sizes (of course, so that the silhouette still has the right proportions), while lipofilling serves a subtler magnification - by the size, up two sizes. In connection with the technique of implementation, it seems obvious that lipofilling cannot be carried out in very slim women, because they do not have adequate deposit of their own fat in the delivery area - stomach, thighs, hips.

Breast lipofilling - benefits

The benefit of this treatment will be the natural contour, shape and filling of the breast with simultaneous reduction of adipose tissue in the donor area (usually thighs, hips, lower stomach). However, it should be borne in mind that the volume of adipose tissue collected from these areas will not correspond to the final breast volume after the treatment in a 1: 1 ratio - a large part of the fat used to shape the bust will absorb, hence some thinner patients qualified for the procedure are recommended even small gain weight and increase the fat deposit before lipofilling is done.
The advantage of making breast enlargement with your own fat tissue is the lack of the feeling of a foreign body, which may initially cause patients with the implant discomfort.

Indications for the procedure

The patient will be qualified for surgery, the expectations of lipofilling are real (she does not expect a very large increase in breast size) and she is not oncological burdened. Lipofilling will be suitable for women who:
• want to compensate for the asymmetry in the left and right breasts
• they want the breasts to return to their full shape before breastfeeding
• they want to improve the contour of the bust in a small range of sizes in a subtle and natural looking way
• have postoperative losses, e.g. in the chest muscle, which distorts the bust
• lost weight at a rapid rate, and thus the breasts lost their firmness

Contraindications for the procedure

If there are serious comorbidities (poorly controlled diabetes, heart and kidney disease) and if after an oncological consultation (including a family history aimed at the occurrence of cancer in the family and genetic testing for the presence of mutations in the gene, among others BRCA1), it turns out that the patient is oncological burdened, breast lipofilling treatment is contraindicated, unfortunately. The decision to terminate the procedure in this case is justified by the fact that calcification in breasts after lipofilling makes it difficult to control patients at risk of breast cancer as part of screening (USG, mammography) because they distort the image and it will be difficult for post-operative calcification to distinguish postoperative calcification from those that arise in the tissue of the mammary gland under the influence of cancer.
There is also no surgery in patients with insufficient subcutaneous fat deposits, and therefore very slim, due to the difficulty in obtaining the right amount of material for transplantation.

Before the surgery

Preparations for the procedure mainly include the necessary oncological consultation, which was already mentioned in this study. It is worth to find out if there were cancer in the family, if so which, in whom and in which generation. In addition to the oncological risk assessment, a standard surgical consultation takes place, taking into account co-morbidities, taken medications, past treatments and reactions to anaesthetics, if previously administered.

Type of anaesthesia

Breast lipofilling is performed under general anaesthesia, taking into account the relatively large scope of the procedure - first, activities must be carried out to collect fat from around the hips, thighs and abdomen. Only later can the "proper" part of the procedure take place, i.e. filling the breast with properly filtered fat.
General anaesthesia, commonly referred to as narcosis, aims to temporarily and reversibly relieve the sensation of pain, reflexes, patient awareness as well as muscle relaxation. Usually, such anaesthesia takes place in two stages: in the initial phase, the patient is given sedatives, aimed at relaxation and reducing the stress associated with the surgery itself. Then the appropriate anaesthetic is given and this can be done in various ways - usually intravenously (other: inhalation, intramuscular, rectal).
General anaesthesia is considered to be a safe procedure for the majority of patients and used for a wide range of surgical procedures, however there are certain risk groups that are more likely to have intraoperative complications - such as obese people with coagulation disorders, poorly controlled diabetes, breathing disorders, hypertension. However, these are rarely complications related directly to anaesthesia (unless there have been no adverse reactions after administration of anaesthesia), but rather to the patient's own health condition. The risk of subjecting the patient to general anaesthesia, of course, is to be evaluated by the attending physician and anaesthesiologist.
The surgery usually takes about 2 hours, which, however, may change depending on the amount of transplanted adipose tissue.

How does the procedure work?

Breast lipofilling can be divided into several stages. The first is to determine the places from which the material will be obtained and the body fat will be taken from the donor sites (thighs, hips, abdomen) using special, blunt cannulas introduced into small incisions in the skin. Fat cells are collected with the help of systems connected with negative atmospheric pressure. The second stage of the procedure, equally important for the final visual effect, is adequate separation, ie the separation of fat cells from the morphosis elements of blood, serum and fat in liquid form from the damaged during the collection of adipocytes. Only undamaged fat cells are selected for implantation, which prevents the subsequent formation of necrosis of the necrosis in the breast. The final stage is supplementing with the obtained fat of the breast glands - this is also done by small incisions in the skin, through which the surgeon introduces small cannulas (tubes) and can put fat under the skin with small drops. This is done in different areas of the breast. Notches after cannulas are usually closed with one suture or special plasters, and the traces of them are only visible minimally. It should be remembered that not all transplanted tissue during lipofilling will "take" - some will be absorbed in the healing process, so one should not expect a 1: 1 volume effect.

Time and course of convalescence

A stay in the clinic usually does not last longer than a day, small areas of bruising and swelling can last up to several days. In general, the patient returns to normal activity a week after surgery, but not too much.

Effects after surgery

The effects can be assessed after complete elimination and elimination of edema from both the delivery and the recipient areas. The optimal time to assess is about 3-6 months. If the procedure was only carried out as recommended and based on correct operative techniques, the effects are usually satisfactory. We can expect an improvement in the shape and contour of the bust, as well as modelling the areas from which fat was taken to lipofilling - thighs, hips, buttocks, abdomen. It can therefore be said that the effect of such an operation is a general modelling and shape of the figure, with emphasis on the breast.

Recommendations after the procedure

Immediately after the procedure, it is said to give up tanning for about 4 weeks, because skin discoloration may occur. For about a week, physical activity is limited, due to the possibility of small bruising and swelling of the patient, they usually also avoid sleeping on the stomach for the initial period of convalescence. In addition, there are no restrictions on the activity after complete healing of the place of administration and reception.
One should be aware that such a correction involves the necessity of regular ultrasound and mammographic monitoring due to the formation of microcalcifications in the breasts similar to those formed in the course of the cancer process. Microcalcification itself is a natural phenomenon, however, there is a risk of missing an ongoing proliferation process among postoperative changes.

How long do the effects last after the treatment last?

How long the effect lasts is really an individual matter. After healing and absorbing part of the adipose tissue, the patient may decide to undergo another treatment if she is not completely satisfied with the effect. It is important that unlike the implant, the transplanted adipose tissue is subject to all metabolic processes that can be affected by living tissues, so for example when the weight loss is high, we can also expect a decrease in breast volume. Ideally, when a patient undergoing lipofilling tries to maintain a constant weight - then the effect will last as long as possible.

How to avoid complications after the procedure?

To avoid complications of breast lipofilling, a complete medical examination should be submitted for consultation. On the part of the patient it is actually the only thing that can do - the rest is in the hands of properly qualifying doctors and a trained anaesthesiologic and surgical team.
Possible complications after the procedure
The breast lipofilling procedure, like any surgical intervention, additionally carried out under general anaesthesia, carries with it the possibility of complications, both those directly related to anaesthesia and the procedures. You should talk to an anaesthetic team doctor about complications related to anaesthesia, because they are unforeseen, but they happen relatively rarely. Typical surgical complications associated with the surgical procedure are:
• infections - although due to the high standards in the clinics and the tools are sterile, complications in the form of wound infection are rare,
• adipose tissue necrosis - when the implanted tissue is colloquially saying "it will not take" - there are small outbreaks that usually resorb spontaneously; larger foci of necrosis require reoperation
formation of a subcutaneous hematoma - as a result of damage to the vessels during the procedure
These complications, although there are exceptions, of course, are not serious and can be successfully treated.

Recommended additional treatments after the procedure

If the patient is not satisfied with the final effect of breast lipofilling treatment, she may consider performing the same procedure and supplementing the breast with a larger volume. If the patient wants to decide on a less invasive procedure, an interesting option is shaping the breast with the help of PDO threads. If it is ready for the next surgery to meet her expectations for larger breasts, it is worth considering implantation of implants - not only round, but also anatomical, so-called implants are available. "Tears", allowing for an equally natural effect. However, it involves a slightly longer convalescence.

Author: Wiktoria Feret, MD
Literature:
Grabb & Smith Plastic Surgery, VI-th edition by Charles H. Thorne, Lippincott Williams & Wilkins 2007; Plastic surgery, Jurgen Holle, PZWL Warsaw 2013

We invite you to use our search engine clinics, offices and medical facilities located in Poland, offering breast lipofilling (enlarging the breast with a transplant of your own fat)