However, professional plastic surgery societies have gradually changed their stance on fat transfers into breasts as the technique has evolved. In the late 1990s, ASPS issued a very strong statement against the practice. This ambivalence toward the technique lingered; in 2007, the ASPS issued a press release titled “Plastic Surgery Societies Issue Caution on Fat Grafting for Breast Augmentation,” in which it, along with the American Society for Aesthetic Plastic Surgery (ASAPS), announced that “fat grafting for breast augmentation is not recommended at this time based on the lack of safety and efficacy data.”
In January of 2009, however, the ASPS issued guidance on the procedures that took a softer approach, stating that, “Based on available literature, complication rates associated with fat grafting are not, overall, unduly high,” and that “Concern regarding the interference of autologous fat grafts with breast cancer detection is not validated by the limited number of studies available on the topic.”
Khouri hopes his technique will foster further acceptance of the procedures. On Sunday, Khouri hosted around 200 plastic surgeons from around the world to a seminar to demonstrate his new approach. Using the BRAVA system — a vacuum suction device that a woman wear to expand the tissue of the breast — Khouri said he can prepare the breast to receive the fat that has been harvested from another part of the body. Rather than depositing all of this fat in one place in the breast, Khouri’s approach involves about a dozen injections per side to ensure that the fat has enough room to take hold and survive.
“We’re not trying to stuff or force a lot of stuff into a tight space; it’s like putting seeds in a field,” he said. “You can stuff a lot into a small pot, and they’re not going to grow. But if you take the seeds in that pot and stretch it into a large field, you’re going to get growth.”
Khouri has research to back up the technique; at the European Society of Plastic and Reconstructive Surgery (ESPRAS) meeting in September, he presented a study which looked at the technique in 50 women. On average, 85 percent of the fat transplanted into the women’s breasts survived. And on average, these women experienced 210 ml of augmentation per breast from the technique six months to a year out.
As for when the technique could become more widely used, the picture is unclear.
“Basic research is costly; it requires financing,” Biggs said. “The interest is there, but two or three voices can only do so much.
“I can’t give you an answer in terms of number of years. All we know is that we’re going full speed ahead.”
If and when the procedure does become a mainstream treatment, Biggs said it was unlikely that the procedure would supplant artificial implants — at least not yet.
“For augmentation, breast implants themselves have been improved so significantly, a person may prefer to have an implant rather than enduring the longer time it takes for grafting,” Biggs said.
Other plastic surgeons agreed. “To think that you can actually take a woman from an A cup to a C cup with fat transplants is unrealistic,” McGuire said. “The best use is really in a post-mastectomy breast reconstruction patients who…[have] residual post-reconstruction defects after their operation.”