Breast augmentation by lipofilling
The strengths of breast lipofilling
- Natural result without foreign bodies
- No visible scars
- Suitable for moderate breast augmentation
Description of breast lipofilling
Breast lipofilling is an autologous breast augmentation technique, i.e. using your own tissue. It avoids the use of silicone breast implants, although mixed techniques can be proposed (placement of breast implants and lipofilling at the same time). The principle is to remove fatty tissue in the least traumatic way possible, to separate the fat from the blood and oil coming from the damaged fat lobules, and then to reinject the purified fat into the breast to increase its volume.
It is therefore a double operation combining liposuction and breast augmentation. The patient thus obtains a double aesthetic benefit with a reduction in waist and thigh circumference, a disappearance of the saddlebags and a breast augmentation of one cup per operation. It is a tissue graft. The transferred fat will survive thanks to the blood supply of the breast tissue into which it is transferred. The result at 1 month is then totally stable over time and will even accompany your weight variations (the breasts will grow in case of weight gain).
Breast lipofilling is intended for women who want a moderate breast augmentation (about 1 cup per session), giving a natural result without breast implants.
The main advantage is of course to do without breast implants to obtain a breast augmentation and therefore to obtain a natural breast augmentation. This avoids the complications of implants that are ruptures (and therefore the need to change the implants every 10 to 15 years) and shells.
The fat is not felt as a foreign body and the operation cannot be detected either by touch or by sight. Moreover, the scars are almost invisible. The second major advantage is the aesthetic benefit of liposuction, which is performed to remove the fatty tissue. The patient loses an average of one pant size by removing excess fat such as saddlebags.
The first major disadvantage of this technique is that it only allows the volume of the breasts to increase by a maximum of one cup per session. New techniques seem to improve the take of the fat graft at each session, in particular the prior expansion of the breasts by suction or BRAVA technique. However, this last technique is expensive and very restrictive for a small benefit.
The second disadvantage is rather a limitation. Lipofilling can only be considered if you have enough fat to achieve the desired breast augmentation. It is therefore impossible to propose a breast augmentation from a B to C cup by lipofilling to a skinny woman with a size 36. Finally, the operating time for breast lipofilling is longer (2 hours compared to about 1 hour for a breast augmentation with implants).
The first contraindication is, of course, patients who are too thin to be able to consider taking enough fat for a bilateral breast augmentation. Indeed, to inject 300 cc of fat into each breast, a minimum of 1.5 l of fat must be removed during liposuction. This corresponds to the removal of the saddlebags, the anterior abdomen and the inner thighs.
On the other hand, this technique is not indicated in case of a history of breast cancer because of the modification of the breast architecture. It should be noted, however, that trials have been carried out on women who have had breast cancer and for whom breast lipofilling has been performed to correct the aesthetic sequelae of radiation. They did not show an increase in the rate of local recurrence of cancer, which is very much in favor of the safety of this technique.
Finally, smoking more than 10 cigarettes a day is a contraindication to breast lipofilling because the fat graft will take less. For more information on this topic, see our blog post about the new recommendations for fat injection in the breasts.
Procedure: how does breast lipofilling work?
The preoperative consultation is probably the most important part of your breast augmentation procedure. We check that your morphology is suitable for breast lipofilling, we look for possible contraindications and we explain at length the advantages and disadvantages of this technique. You will be given a specific information sheet.
We systematically request specific imaging of your breasts before breast lipofilling. These examinations must be done by a radiologist specialized in breast imaging. You will need to have a digital mammogram, a breast ultrasound and a magnetic resonance imaging. If the examinations are perfectly normal, the operation can be considered.
A compression girdle and compression stockings will be prescribed and must be ordered before the procedure. If you smoke, nicotine patches or an electronic cigarette must be ordered in order to avoid smoking for 15 days before and after the operation. Finally, a consultation with your anesthesiologist is mandatory in the month preceding the operation. No blood test will be required unless you have a specific history of blood loss.
Breast lipofilling is performed under general anesthesia during a day hospitalization (ambulatory surgery). You must fast for 6 hours before the procedure begins and a detersion with a betadine shower must be performed at home. All piercings, earrings, jewelry and false nails must be removed.
When you are admitted to the operating room, the usual checks are carried out (safety checklist) and then the procedure begins after you have fallen asleep.
You are first positioned on your stomach to remove fat from the lower back, the saddlebags and the inner thighs. This removal is done with specific liposuction cannulas of small diameter (3 or 4 mm) with many small holes allowing to remove only the small lobules of fat that are more resistant to the grafting process.
In addition, the liposuction machine is set to establish a suction twice as low as that normally used. Then, you are placed on your back to remove fat from the front of the thighs and stomach as well as from the inner side of the knees. At the same time, we begin the fat purification process. Unlike a traditional liposuction, the fat is not discarded but is collected in a sterile jar between the cannula and the liposuction machine.
The fat is then transferred to a medical device for purification. 2 options are possible:
- a centrifuge that separates the fat into surface oil, purified fatty tissue and blood by the action of centrifugal force.
- a specific PureGraft® filtration bag allowing to treat large volumes of grease. We now use this technique almost systematically despite its high cost (400 €). Indeed, it is a closed system (the fat is not in contact with the air, which reduces the risk of contamination by bacteria) which filters the fat without any deleterious mechanical action. We obtain a better quality fat with high grafting rates.
This makes it possible to obtain 500 to 800 cc of pure fat per procedure. The fat is then injected by means of very fine cannulas through multiple millimetric entry points. Up to 400 mL of fat can be injected per breast and per session. A compression garment is put in place at the end of the procedure and you can go home 4 hours after the end of the operation.
The aftermath of the operation
The pain is moderate. An edema at the level of the collection sites and at the level of the breasts appears during the 48 hours following the breast lipofilling procedure, and will generally take 1 to 3 months to be resorbed. Bruises appear in the first few hours in the fat collection areas: they disappear within 10 to 20 days after the procedure. Some fatigue may be felt for one to two weeks, especially in the case of fat removal and major liposuction.
The girdle must be worn for 3 weeks and massages such as palpe-roulé must be performed on the body from the 5th day. No specific care is required for the breast other than wearing a non-compressive sports bra.
The breasts appear very swollen the first week. You should not wear a bra for the first 5 days in order not to compress the injected fat. The volume of the breasts decreases until 1 month after the operation when their appearance is almost definitive.
Care and precautions
It is important to understand that immediately after the breast lipofilling procedure, the breasts are very swollen and have a significant edema, which corresponds to an increase of 2 cups. In 15 days, the edema will disappear and the breasts will lose about 30% of their volume. The final result of a lipofilling procedure can only be appreciated at least 1 month after the operation. In the end, the breasts will have an average increase in volume of 1 cup and a more harmonious shape. The silhouette is also improved thanks to liposuction of the areas where fat was removed (saddlebags, stomach, knees).
A new procedure can be considered 3 months after the first lipofilling in order to obtain an additional cup size.
Questions and Answers
It seems that the injected fat does not hold, is it true?
No, the fat injected into your breast will graft itself thanks to the blood coming from the surrounding tissues. During the grafting process, approximately 30% of the injected fat volume will not take but 70% will survive and give you the aesthetic result in the long term.
Is the result of lipofilling the same as with breast implants?
No, lipofilling allows for a maximum breast augmentation of one cup size, or about 180 cc. With breast implants, two or even three cups can be gained. In addition, a breast lipofilling does not provide a maximum projection and cleavage as with a breast implant. On the other hand, the result is perfectly natural and there is nothing to distinguish a breast that has been remade after lipofilling.
Is it possible to combine implants and breast lipofilling?
Yes, this is called mixed breast augmentation. The main interest of this procedure is to hide the top of a breast implant in the neckline. This allows the implant to be placed in front of the muscle, even in skinny patients. Thus, the procedure is much less painful and the result more natural.
Have a question? Please contact us!
Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France