Breast augmentation without the use of implants employs the latest in cutting edge use of FAT.
FAT is used all over the body to create shapes and contours. Dr. Nasir is a renowned breast surgeon with extensive experience using implants to augment the shape and size of breasts. However, a new era is upon us where fat harvested from the abdomen or thighs is transferred to the breast to achieve the same aesthetic result as the implants. With the introduction of new techniques to harvest, treat and transfer fat, Dr. Nasir feels that fat will soon be recognized as the universal ingredient to beautify and rejuvenate the body.
Currently, Dr. Nasir uses PUREGRAFT. It is a processs by which fat is harvested, processed, and delivered without “seeing air.” This has been shown to increase the survival of the transferred fat, allowing more specific volume transfer and artistic security.
Natural Breast Augmentation without Implants
Fat transfer via liposuction from one area of the body, such as the abdomen, flanks, thighs to enhance breast size, shape, symmetry or change the shape of the breasts (such as in Tubular Breast deformity or in marked congenital asymmetry)
This technique is used in breast reconstruction with or without implants. When used with implants it helps to correct contour defects which are not correctible with an implant alone, such as hollows, lack of proper shelfing, cleavage, etc.
Use of Fat to Augment the SIZE of a breast or to fill an “empty” skin envelope after weight loss or childbirth (breast feeding)
Ideal Candidates
- No family history of breast cancer. No Braca 1 or 2 gene: these are contraindications
- Understands that transferred fat is a graft and that no guarantee of survival is given and that it may take a couple of sessions to achieve optimal results
- Has fat to give: abdomen, thighs, hips, flanks, back, arms
- Realistic expectations of improvement
- Cannot get beyond the foreign body fears of an implant
- Does not want general anesthesia
- Wants improvement not dramatic change
- History of capsular contracture after failed implant augmentation
- Tubular breast deformity
- Congenital breast asymmetry
The ASPRS had a task forces to study the indications, complications and risks of Fat Transfer to Breasts (specifically) in 2009 and found: No increased incidence of cancer, no interference with mammograms or MRI studies with detection of cancer, no contraindications to the use of this technique with the stipulation that the results were VERY physican-experience and technique dependent.
Fat survives as a “grafted” tissue, that is, the fat is taken from one site, and transferred to the second site and only survives is the blood vessels from the donor fat connect to the recipient vascular bed. Accepting this, one can see how every detail of the procedure will determine the survival of the transferred fat.
Patient factors
- Healthy patient with well vascularized tissues at both donor and receiving sites
- Non-smoker
- Non Diabetics
- No history of chest radiation
- No scarring at donor or recipient site
Technique Factors
- Fat taken with low vacuum (PUREGRAFT)
- Atraumatic cannulae for procurement of fat
- Fat not transferred with minimal “handling” in the OR (PUREGRAFT)
- Centrifuged at proper gravitational force to separate from blood and local but not to injure cell walls (PUREGRAFT)
- Delivered into the recipient bed with minimal trauma: size of cannula and gentle pressure (PUREGRAFT) system
- Anaerobic system to maintain integrity of viable adipocytes (fat cells) (PUREGRAFT)
- Transfer from well vascularized zone to well vascularized zone, eg, knee fat is more vascular than abdominal fat
- Transfer to deep layer of breast on muscle where there is rich vascular bed as opposed to breast tissue per se which is poorly vascularized
- Antiobiotic coverage pre and post op
- Gentle technique to avoid bleeding (blood will prevent graft “take”)
- Aesthetic vision of surgeon to distribute volume to achieve optimal breast aesthetics. Not all about BIG!
Procedure is performed under local anesthesia, with oral sedation (Xanax and Vicoden). Patients are comfortable. Length of procedure about 1 hour. Post op, patient wears a support bra for 2 weeks. She can resume lower body exercise in 48 hours but not engage in any upper body workouts for 2 weeks. She can shower in 24 hours. She will also wear a compressive garment at the donor site, eg, abdominal binder or biker shorts, if this applies.
The “take” status of the breast volume will be judged after 3 months. Initially, there will be swelling from the procedure which will remit in 4 to 5 days. As usual, the recipient contour improvements will also take 3 months.
It may be necessary to perform a secondary procedure for more volume or symmetry. This can be done after the 3 month mark.
Content courtesy of drjameslyons.com
