Introduction:
We undertook this prospective study to determine with modern breast imaging technology the safety and efficacy of breast augmentation with liposuctioned fat.
Materials and Methods:
After IRB approval and informed consent, 50 women (age 17-63) underwent 55 fat grafting procedures on 97 breasts (3 unilateral, 5 women grafted twice). To optimize the recipient breast, they wore 10 hours/day for four weeks, a bra-like external tissue expander shown to augment the graft recipient volume and to be angiogenic. Under tumescent anesthesia and sedation, using 2.7mm cannulas and 300mm/Hg syringe vacuum, we harvested 250ml of fat per side (range 90 - 450ml). The fat was separated by sedimentation and diffusely re-injected into the breasts through 10 - 14 needle puncture sites in a three dimensional fanning pattern, micro-weaving the grafts using 2.4 mm cannulas and meticulously avoiding localized collections. Twelve hours post-procedure, they resumed expander wear and used it as a stent as much as possible during the first week tapering the wear down over the next few weeks. All patients had a baseline MRI of the breast; the first 23 had an MRI 3months post grafting, and all had another MRI at 6 - 12 months. A mammogram was obtained one year post grafting in women over forty. Breast volumes were derived from 3D volumetric reconstruction of the MRI scans. Follow up ranges from 5 years to 9 months (Average 3 years).
Results:
As we refined the technique, operating time for bilateral augmentation was reduced from 5 to 1.5hrs. All patients returned to their normal activities within 3-4 days. Breast volume was unchanged between the 3 and 6 months MRI measurements (p>0.2). Thus the 3month MRI was discontinued for the remainder of the study. Average augmentation volume at 6-12 months MRI was 210 ml/breast (90ml - 360ml). On long-term follow up, breast volume changes were commensurate with BMI fluctuations. Graft survival averaged 85%  (70% - 120%). There was a direct correlation between maximal pre-grafting expansion and the resultant final breast volume augmentation. Patients were all pleased with the natural feel of their enlarged breasts and the improved appearance of the liposuctioned donor sites. There were no suspicious breast masses or nodules. MRI recognized an 18% incidence of fat necrosis and the one-year mammogram identified them all. More importantly, the radiologist had no difficulty interpreting any of the studies. The only complication was a low-grade infection in a woman with asymmetry and pectus who had extensive grafting of the breast parenchyma.
Summary/Conclusions:
Atraumatic low pressure harvesting with fine cannulas, minimal fat manipulation, and diffuse periglandular graft placement as microdroplets through multiple injection ports in a pre-expanded, hypervascular bed can achieve excellent long term graft survival leading to pleasing aesthetic breast augmentation. Fat necrosis is a rare event that is recognizable by modern breast imaging techniques. The procedure we performed did not create any lesion that might interfere with cancer detection.
Therapeutic intervention. Women 17 - 63 interested in autologous breast augmentation. Exclusion: smoking, Significant co-morbid conditions, pregnancy, poor compliance with device use.