Is the transfer of adipose tissue into the breasts really possible?
Yes, breast lipofilling, breast fat grafting or the lipomodelling of the breasts (term put forward recently for fat grafting at the level of the breasts) is absolutely feasible. This procedure uses excess fat, from the hips, for example, to improve the aspect of the breasts.
Who would benefit from lipofilling or lipomodelling of the breasts?
The indications for lipomodelling of the breasts span over a generous range. This technique has completely revolutionised breast reconstruction, allowing for high quality results. Furthermore, lipomodelling has multiple indications in reconstructive surgery after conservative treatment of breast cancer and in the treatment of breast malformations. In aesthetic surgery, lipomodelling may be used exclusively or in combination with a prosthesis (called composite breast augmentation).
Does the intervention consist in two parts?
Yes, the first part consists in harvesting the fat, frequently from the hips (the patient is in prone position), after which the fat is treated and within the same intervention (second part) the patient in turned on her back and the fat is transferred to her breasts.
Is a second intervention necessary 3 months after the first lipofilling?
This depends greatly upon the indication. Provided the surgery is reconstructive, two sessions of lipofilling are often needed to obtain the desired result (surgeries are to be scheduled from the onset). On condition that the surgery is aesthetic, habitually only one session of lipomodelling is arranged (cost limitation of each surgery). If the patient requests a second session, on condition that she has enough fat left, that is certainly possible, taking into account that this second surgery has its own indication and explanations.
How does the fat graft work?
Lipomodelling consists in a true adipose tissue graft. The fat injected may survive if within 1 mm of the surrounding tissues, by neovascularising itself. This is the reason for which fat tissue grafts are realised in the form of 2 mm diameter spaghettis. If the 2 mm diameter is exceeded, the fat graft survival is endangered and can lead to fat-necrosis lesions.
Regarding aesthetic lipomodelling, is it possible to gain more than one size in bra cup?
Generally, one should not expect to gain more than one cup in bra size. If a patient would like to augment her breasts two sizes or more, it is advisable to consider a Composite Breast Augmentation (combining lipomodelling and prostheses).
For how long does the result obtained after a lipomodelling session last?
The result of lipomodelling will rest definitively. Three months after the intervention, the final volume is obtained; after this, if the patient maintains the same weight, the volume rests the same as well. If the patient loses weight, the volume will diminish. Conversely, if the patient gains weight, the volume will augment.
Do several techniques of injection exist?
Yes, numerous harvesting as well as transfer techniques have been described. Regarding the harvesting technique, we remain faithful to the syringe technique as it is by this means that the fat is least traumatized and the result obtained at the site of harvest is the most satisfying. The inconvenience of this technique is represented by the fact that the technique is lengthy and strenuous for the surgeon, but profitable for the patient, in terms of the quality of the fat harvested and the amount of fat that survives once injected at the desired site.
The transfer techniques must be mostly uniform. Achieving a very fine, very precise three-dimensional grid is a matter of experience (learning curve), hereby avoiding fat-necrosis and enabling a better survival of the fat graft.
What are the risks of lipomodelling?
The surgical risks of lipomodelling are very low. As long as there is no undermining, there is no risk of hematoma. The probability of infection is very poor (frequently, the risk of infection is linked to the development of a hematoma). The minor risks are related to fat-necrosis, which is dependant of the experience of the surgeon. Factors promoting fat-necrosis are represented by microcirculation issues connected to diabetes and smoking. Also, the cessation of smoking is advisable and strongly recommended one month before and after the surgical intervention and possibly indefinitely, for the future preservation of health and the beauty of the patient.
What is composite breast augmentation?
Composite breast augmentation combines a breast augmentation by prostheses with an augmentation by lipomodelling. The prostheses generate the volume, while the lipomodelling provides the detail, notably at the level of the cleavage (décolleté) and the periphery. The results obtained employing this technique are extremely satisfying, which is why this technique is starting to be used more and more frequently in breast augmentation surgery. (cf. Composite Breast Augmentation direct link).
What about the interpretation of mammographies and ultrasounds?
A patient in which a lipomodelling session has been done corresponding to the guidelines will experience only a little fat-necrosis, if any, provided the absence of risk factors like diabetes and smoking. Therefore there is no impediment to interpreting mammographies or ultrasound images. At the time of the yearly check-up, one can observe tiny oily cysts (ultrasound), that have no clinical implication and do not change the ACR class (they do not impede the quest for a breast tumour). Breast lipomodelling done by experts in patients without any known risks does not compromise breast cancer screening.
Is it true that fat grafting promotes breast cancer?
We have received an impressive amount of feedback since we have started using lipomodelling in 1998 and the fact that lipomodelling does not promote breast cancer seems generally recognised. In cases of high risk of recurrence, notably the sequelae of conservatory treatment, the local recurrence rate is lower than expected, which makes us wonder whether there might be a probable protective role associated with lipomodelling. We are currently actively investigating this supposition.
One of my friends has experienced some type of lumps in her breasts after an aesthetic lipomodelling; is this normal?
The lumps at the level of the breast are oily cysts or areas of fat-necrosis. One or two oily cysts after a lipomodelling of the breasts occur in 10 to 15% of cases. The treatment is simple and consists of draining the cyst and establishing the diagnosis (there is no differential diagnosis if the only expression of the cyst is oil).
Conversely, if the whole breasts presents multiple cysts, one has to wonder if the technique was faulty or if the indication was incorrectly given. The explanation may be tied to an inexperienced surgeon, a very fast lipomodelling session, or lipomodelling done without respecting the rule of the fat spaghettis. Another explanation could be the microvascular sufferance in a smoker. If the vascularisation of the receiving tissue is not the best, the survival of the adipose tissue graft is poorer, which will trigger the appearance of oily cysts and fat-necrosis.
Can lipomodelling be reimbursed by Health Insurance providers?
Yes, in France this is possible, but only within reconstructive surgery. The Assurance Maladie (Health Insurance) has issued new guidelines (applicable starting with the 1st october 2017) related to this intervention, that is called adipose tissue autograft. There are now two new codes QEEB317 (graft less than 200cc) and QEEB152 (graft more than 200cc) to be employed for fat transfer at the level of the breast.
The reimbursement is limited to breast reconstruction, conservative treatment sequelae, asymmetry and breast malformations such as tuberous breasts or Poland syndrome. The Health Insurance covers the Sécurité Sociale part of the costs, but in private practice, the « complementary fees» is the responsibility of the patient and her complementary insurance.