Some of the plastic surgery heavyweights behind fat injections for breast work — reconstruction and augmentation — will appear at the ASPS meeting in November to discuss the value of injecting fat into breast tissue for a variety of purposes. The issue has been covered in a well-written news article published this week on WebMD: Are Fat Injections Safe for Breasts?
Reshaping the breasts by injecting a woman's own fat works well for "touch-ups" after breast reconstruction, but is not yet proven effective for breast augmentation, according to plastic surgeons slated to present an update at the annual meeting of the American Society of Plastic Surgeons (ASPS) in Chicago.
"For breast reconstruction, there are some good data to support the safety and efficacy of fat injections, but for cosmetic use, it's a whole new ball game," says William P. Adams Jr., MD, a Dallas plastic surgeon and associate clinical professor of plastic surgery at the University of Texas Southwestern Medical Center, Dallas. He is among the doctors scheduled to discuss the technique at the Oct. 31-Nov. 5 meeting.
But no studies as yet prove the effectiveness and safety of fat injections for breast augmentation, Adams says.
However, such studies may soon be under way. Two clinical trials are now seeking women to help study fat injections (also called fat grafts) for breast enlargement.
And some experts seem to be warming to the idea of fat-enhanced breasts. At the meeting, a task force assigned by the ASPS to study fat injections plans to issue its conclusions. Although the task force stops short of making recommendations about fat injections, it suggests they "may be considered" for reconstruction and augmentation, says Karol A. Gutowski, MD, head of the division of plastic surgery at North Shore University Health System in Chicago and the task force chair.
In 2007, The American Society of Aesthetic Plastic Surgery and the American Society of Plastic Surgeons issued a joint statement of caution about fat injections for the breast, noting that they can be effective in enhancing breast appearance after reconstruction or to soften the appearance of implants in place, but not recommending fat injections for augmentation, citing a lack of data and the fear of hindering breast cancer detection.
The whole issue of using a patient's own fat to help in breast reconstruction after surgery seems to be A-OK, according to the MDs quoted in this article. So what's the hang-up when it comes to augmentation? No standard approach? Well, I'm certain that is in the works. Practitioners such as Sydney Coleman, Roger Khouri, and Gutowski are clever, smart people who will certainly come together on a standard way to augment breasts with the patient's own fat cells.
In 2007, the ASPS and the ASAPS issued a joint statement cautioning about fat injections for the breast, noting that they can be effective in enhancing breast appearance after reconstruction or to soften the appearance of implants in place, but not as a replacement for breast implants. These organizations cited a lack of data and a fear of hindering breast cancer detection. The annoucement coincided somewhat with the FDA's lifting a ban on the use of silicone implants for breast augmentation.
Who should really be fearful about fat grafts for breast enhancement? How about… the companies that manufacture breast implants. They have good reason to be afraid. One, the number of companies in that niche are few and there is a lot of cash tendered over the sale of both silicone and saline implants. Where is Mentor, arguably the Number One player in this market, in the debate over efforts to make fat grafting safe and legal?
The elephants in the room, which include Mentor competitor Inamed, are not named in the WebMD article but their presence is felt — and will be felt at the ASPS meeting. More on that at a later date.
Ultimately, the writing is on the wall regarding what women want when it comes to breast enhancement. The days of pumped-up, plumped-up, dangerously overdone fake boobs are numbered. There are simply too many Web sites with photos of before-and-after "bad plastic surgery" horror stories — not to mention the "way after" photos showing enhanced breasts prior to the inevitable years-later revision surgery.
With the increased media and Internet attention on the long-lasting effects of this super-boob "look" — the porn-star variety of "perfect beauty" that the media promotes as though porn stars are the modern Greek goddesses — many people are eschewing that dubious look and have — or will — consider safer, more natural-looking alternatives.
For example, so many boob jobs need to be redone at a later date, an entire industry within plastic surgery has grown up around breast revision. Many more women are getting enhancements earlier in life and reporting back to other women: "Hey, girls, it may not be all it's cracked up to be." Many women still want the implants, but over time, as fat grafting, stem-cell-based solutions, and other futuristic approaches catch on, the implant business may be, uh, supplanted by other possibilities.
Here's one I hear all the time: Silicone implants "look better." So say surgeons who are quoted throughout the media reportage on breast enhancement. Yet, how often do these same quoted physicians harp on the controversial safety record of implant technology? Again, where do Mentor or Inamed stand in this debate?
Clinical trials will go a long way to resolve the issues surrounding fat grafting for breast augmentation. The WebMD article cites 2 studies already underway.
The article concludes with an undeclared comparison between breast-enhancing implants and the prospect of fat injections to achieve a same or similar result:
Adams and other experts say that aside from the need to prove fat injections for augmentation safe and effective, there are other issues for women and physicians to consider. They include:
Time. Breast augmentation with implants may take about an hour to an hour and a half, but breast augmentation with fat can take five or six hours, Adams says. "A lot of patients need to be re-injected," he says.
Expense. The average surgeon's fee for implants is about $4,000 and for liposuction about $3,000, according to the American Society of Aesthetic Plastic Surgery. But breast augmentation with fat injections can cost about $20,000, Coleman says.
Results. With implants, "the typical enlargement is two cup sizes," Spear says. "And 99% of the time the patient ends up with a predictably enlarged breast. The downside is, they have an implant that may not feel entirely natural and may have to be replaced in their lifetime. Fat injections rarely enlarge more than one cup size, often less than that, and the results are not predictable or guaranteed. But when it is successful, they have a breast that is their own tissue."
"…when it is successful, they have a breast that is their own tissue." There's the key statement in this debate. If given a choice between having an alien device implanted in their chests and using their own tissue to achieve the same or similar enhancement, women will want to choose the latter.
What about some of the current thinking regarding fat grafting — that the results, for instance, only last as long as 5 years, that the fat is slowly reabsorbed, and that only 10% to 15% will actually stay in the breast? One can only hope that these are related to technology and safety concerns that will eventually get worked out.