Another study supporting the use of fat grafting for breast reconstruction has been published in the Journal of Plastic Surgery. This time supporting the use of Implants in combination with fat grafting as I have been doing for my breast augmentation patients and our CleavageAug procedure. The study specifically chooses breast cancer patients  who have had radiation treatments. These patients are known to have a higher risk of complications with implants, such as capsular contacture or breakdown of the tissues over the implant. Doctors at the Catholic University in Rome, treated 16 patients with fat grafting first to improve the quality of the irradiated areas, and then at least 3 months after fat grafting had implants placed. The results demonstrated a good or excellent outcome in more than 90% of patients with no complications and no capsular contracture. We agree with this approach as an option to more complicated flap reconstruction, particularly in irradiated patients. Using an implant may be necessary if the patient does not have enough fat for complete reconstruction, or she wishes to be larger than can be achieved with fat alone.
Fat Grafting and Breast Reconstruction with Implant: Another Option for Irradiated Breast Cancer Patients. Salgarello et al
Just wanted to add a quick video of Suzanne Somers’ experience with breast reconstruction using stem and regenerative cell enriched fat, similar to the procedure we perform at our facility.
After researching the various options available to her for breast reconstruction, Suzanne Sommers chose the natural alternative, adipose derived regenerative cell enriched lipofilling or fat grafting. Fat grafting is now becoming an accepted option for women who wish to avoid breast implants or complex tissue flaps for breast reconstruction. We offer the same procedure to women seeking this option, as a 100% natural and 100% outpatient option. The procedure is performed at our facility, the Adrecyte Regenerative Medicine and Surgery Center. Read more….
In the latest Plastic and Reconstructive Surgery journal Eric Swanson, M.D. confirms something that has been evident to me for many years. He has reviewed more than 80 publications of breast lift procedures, using all the various techniques, and his measurements of the results published prove that none of the techniques of breast lift are able to provide adequate fullness of the upper part of the breast. He has shown that the techniques that attempt to improve upper pole fullness, such as rearranging or repositioning breast tissue do not work, or at least do not last.
To obtain upper pole fullness I think it is essential to either add an implant to the procedure, or to perform fat grafting to the upper part of the breast. For women who do not want significantly larger breasts, either small silicone gel implants or fat grafting are ideal. The beauty of fat grafting is that the fat can be placed only in the upper part of the breast if desired, and once the fat takes can be expected to be permanent. For women who want much larger breasts, implants are usually the best option. For safety reasons, I recommend adjustable implants known as the Spectrum implant. These implants can be placed at the time of the lift, but only inflated a week or so later, to minimize the risk of tissue loss due to excessive pressure on the nipple at the time of the lift procedure. In 2006 I published a paper with Dr. Hilton Becker using this technique. At that time I had performed over 130 of these, since then I have performed at least 200 more of these procedures. (Augmentation Mastopexy Using Adjustable Implants With External Injection Domes Aesthetic Surgery Journal November 2006 , 26: 6: 736-740 )
More and more, I am performing fat grafting for women who only want more fullness in the upper part of the breast or who only want a moderate increase in size.
For a number of years I have been combining fat grafting with implants to get even better results for my breast augmentation patients, so it was gratifying to hear two plastic surgeons report independently on this procedure demonstrating excellent results. Last weekend I attended IFATS in Miami, an international meeting on the latest in fat grafting and fat derived stem cell therapies. Dr. Eric Auclair from Paris presented his experience with Composite Breast Augmentation, and Dr. Dan Velcchio discussed briefly his approach to bilamellar breast augmentation. Both procedures describe the procedure I have been using  of combining implants with fat grafting over the implants. This can be done at the time of the implant procedure, or as a second procedure later on. Essentially implants are devices that do not perfectly match the shape of the breasts, so that adding fat in strategic places can greatly improve the appearance we can obtain with implants alone. Particularly in a thin individual, fat can be added towards the middle for more cleavage , on the side to cover rippling, and above to smooth the implant edge and add more fullness. Other uses of fat are to correct poorly shaped or tuberous breasts, to correct differences in size and shape between the individual breasts, and to correct underlying chest deformities. The beauty of fat grafting is that the fat can be placed exactly where needed, allowing us to truly sculpt the shape of the breasts. With the added benefit of Liquid Gold Fat Banking, additional fat can be saved to further fine tune the results if needed at a greatly reduced cost.
I just returned from conducting a training workshop for members of the South African Plastic Surgery Society at the magnificent Spier Estate, in the wine growing region near Cape Town, South Africa.
I presented a course outlining the science of fat grafting and regenerative reconstruction and aesthetics. I reviewed the various fat grafting procedures  with particular emphasis on breast augmentation and reconstruction, and explained the advantages of Adipose Derived Stem and Regenerative Cell enhanced fat grafting.
We performed four fat grafting procedures of the face and breast at the Tygerberg Academic Hospital, hosted by Professor Frank Graewe, chief of the Department of Plastic Surgery at the University of Stellenbosch.
The exchange workshop was organized by Cytori, who are world-leaders in inventing and developing the technology of fat grafting and ADRC therapeutics.
The workshop was written up in the Cape Town newspaper, The Cape Argus
Lipofilling or fat grafting may be an excellent option for women who wish to improve the results they have obtained with breast implants, and to correct complications with breast implants such as capsular contracture, rippling, implant infection or extrusion, breast asymmetries and deformities. We provide the most advanced lipofilling (fat grafting) procedures that are  in a 100% outpatient setting, using only your own fat removed with liposuction. We are also able to store fat in our FDA registered LiquidGold lipobank, when staged procedures are required. We are also able to provide regenerative cell enhanced fat grafting procedures which have been shown to be beneficial in some situations such as in women who have had radiation to the breast after cancer. Women who have problems with breast implants or tissue flaps after breast cancer reconstruction may also benefit from lipofilling to improve the results from implants or even totally replace them.
Our facility is a federally and state certified AHCA and Medicare approved facility accepting both self-pay and insurance covered patients.
I have just returned from spending two days in the operating room, mentored by Dr. Roger Khouri, M.D., and observing the full range of procedures now possible with fat grafting, both for breast augmentation and breast reconstruction. Quite simply, the results are amazing. As Dr. Khouri explains, the most important difference between his approach to fat grafting, and that of others, is the use of the BRAVA® external expansion device prior to fat grafting. His results prove, that pre expanding the tissues prior to grafting allow for a much larger volume of fat to be placed successfully at a single procedure. Using the BRAVA® device definitely requires a much more committed patient, someone who is prepared to wear the device 10 hours a day, for 4 weeks or more prior to surgery, and 3 weeks after the fat grafting procedure. For the individual who wants to obtain the best possible enlargement with fat grafting in a single procedure, the BRAVA® device is clearly a major benefit.
In our experience, use of BRAVA® confirms Dr. Khouri’s findings, greatly improving the results possible with fat grafting, particularly in a single procedure. We have found though, that many breast augmentation patients do not want to commit to the inconvenience of wearing the device, even though we strongly recommend it for best results. For breast reconstruction patients on the other hand, I believe the BRAVA® device is essential.
For those individuals who do not wish to wear the BRAVA® device for an extended period of time, smaller more frequent fat grafting procedures may be an option, with or without the use of BRAVA®. Fortunately we now have the availability of the Liquid Gold lipobank, which will allow smaller procedures to be done by banking enough fat from a single liposuction procedure to make this possible.
This last week we performed our first fat grafting procedures where we were able to store additional fat harvested during the same liposuction procedure. Previously when performing fat grafting or liposuction, extra fat was discarded. Now having stored the fat in our Liquid Gold tm mini-fat bank, we can add additional fat as needed with a simple outpatient local anesthetic procedure, without the need for an additional liposuction procedure in the operating room. One patient was a facial rejuvenation volume enhancement procedure and the other a procedure to add additional volume only in the lower part of the breasts where the patient felt that the implants alone did not give her the exact shape she desired.
This procedure can also be used for breast augmentation without implants, and for breast reconstruction.
Fat was harvested using Body-Jet® and then further purified using PureGraft® before micrografting
One cannot simply store fat in a refrigerator, as some doctors have done, so be wary of fat banking that is not performed in a fully FDA registered and compliant facility. The fat must be processed and frozen in a very specific way. The Liquid Gold tm fat bank is the first installed, FDA registered, Cytori Stem Source ® mini-fat bank in the world. Cytori’s proprietary cryopreservation processing procedure has been shown to maintain at least 90% viability of stored fat. Fat viability is the most important consideration of any tissue preservation process as simple refrigeration of fat has been shown to result in total loss of fat viability. Similarly the actual procedure followed during the freezing process is critical so that maximum cell survival during the freezing and thawing process is ensured. The Cytori process has also been shown to maintain maximum viability of the stem and regenerative cells (ADRC’s) found in fat, this is very important as ADRC’s are probably responsible in large part for the survival of fat grafts after grafting, and these cells can also have potential uses in the future. Studies are presently underway worldwide for example using these exact cells to treat heart attacks.
