Breast Augmentation Without Implants

Breast augmentation without the use of implants has been a goal of plastic surgeons for many years. In any instance where we are trying to improve function or appearance, plastic surgeons nearly always prefer to use the patient’s own tissue to accomplish the desired result. This is because when all is said and done, no matter how well made an implant is, it is a foreign object that has the potential for becoming infected, becoming encapsulated and hard, or being extruded from the body. Even though these are rare occurrences, the preference for living tissue remains. It is also what patients would prefer. I can’t tell you how many times over the past 25 years patients have asked me during breast augmentation consultations, “Dr. Lappert, couldn’t you just suck some of this fat from my thigh, or my tummy and just shoot it into my breast?”

The Problem

The problem with transplanting living tissue from one place to another, is establishing a blood supply. When we do breast reconstruction for cancer after removal of the breast, the vast majority of our time is spent planning, dissecting, transferring and preserving the blood vessels so the block of tissue that we move will live in it’s new home on the chest. These are big operations. So big, in fact, that to offer such surgery to a healthy woman who is looking for cosmetic improvement would be like swatting flies with a shotgun.

But the idea of just transferring fat cells all by themselves, the way we move skin grafts from one part of the body to another is very attractive because it isn’t big surgery. Surgeons have been playing around with this for over 80 years. The problem is that fat cells tend to be fragile. Much of what was transferred was already beaten to death by the process. The cells were treated roughly, and placed in large globs, preventing most of the cells from obtaining a blood supply from the surrounding tissue. Also, surgeons until recently, didn’t have a good understanding of what was happening to those cells at the microscopic level, and what the surgeon needed to do while placing the grafts so that the cells would have the greatest chance of making a new home for themselves.

An additional problem was the mistaken idea that fat grafts would make mammograms very difficult to read because any fat cells that die tend to leave little calcium deposits, which is what mammographers are looking for as signs of the presence of cancer. Good science, and logical reasoning has put that objection to rest. It turns out that nearly everything we do to breasts (including mammograms) causes little calcium deposits. The fact is that the calcium deposits produced by cancer cells look very different from the deposits caused by trauma to the breast. Best news of all, studies have shown that fat grafted breasts are more transparent to mammography, so cancers are actually easier to detect.

The Revolution

Thanks to the pioneering work of Sidney Coleman and Gino Rigotti (among others), these techniques have improved so much over the past 10 years, that many surgeons (myself included) find themselves doing more and more breast augmentations using the patients own fat. The technique allows us to build shape in very subtle and natural ways that suit the shape of the patient.

Among the many benefits:
1) No implant
2) Natural feel because it is natural stuff
3) Minimally invasive procedure (tiny little puncture wounds instead of surgical scars)
4) The donor site (where you get the fat from) also looks better (e.g. get rid of the muffin top)
5) Local anaesthetic with light sedation, instead of bigger anaesthesia
6) Very quick recovery

Here is an example of breast augmentation without implants. This was accomplished in a single procedure, in my office, under local anaesthesia. The “after” image was taken 6 months after the procedure.

Depending on your basic shape, and your goals, breast augmentation using your own fat may be the right way for you. Do your homework, ask a lot of questions, make sure you are talking to a board certified plastic surgeon who is a member of The American Society of Plastic Surgeons, and see if this is right for you.*

~Patrick W. Lappert, MD

* Individual result vary with any surgical procedure.

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