Aesthetic Plastic Surgeons Warn of Physicians Who Are Promoting the Procedure as Safe and Effective As a result of the Food and Drug Administration placing restrictions on the use of silicone gel-filled breast implants, women are actively seeking other alternatives for breast enlargement. The American Society for Aesthetic Plastic Surgery (ASAPS), representing board-certified plastic surgeons who concentrate their practices in aesthetic (cosmetic) surgery, is concerned about media publicity on a procedure to enlarge the breasts by fat injection. ASAPS warns that this is an experimental procedure producing only temporary benefits and, more important, posing serious long-term risks to patients.
On the surface, the concept of using liposuction to remove unwanted fat from one's own thighs and buttocks, and then injecting it into the breasts to make them larger, has appeal. However, aesthetic surgeons certified in plastic surgery have long maintained that injection of fat, or any substance, into or behind the breast tissue can be potentially dangerous.
Fat cells that are removed from one body site and injected into another frequently do not survive. Fat injected into the breast may be absorbed by the body, may become liquid and drain from the injection site or may calcify, becoming a scarred mass within the tissues. Massive calcification of injected fat can mask or mimic the presence of breast cancer. Seven to 14 ounces of fat injected into the breast, the amount required for an average enlargement, could make accurate detection of cancer by mammography extremely difficult.
Since the FDA's moratorium on the use of silicone gel breast implants for cosmetic purposes, a handful of physicians from various specialties have been aggressively promoting breast enlargement by fat injection as a safe and effective alternative to implants. Fat injection has primarily been used to correct wrinkles or fill in minor facial depressions, requiring relatively small volumes of fat. The biggest difficulty in these cases is the absorption of fat, resulting in loss of volume and often only temporary improvement in the appearance of the treated area.
Most aesthetic plastic surgeons who have used fat injections to correct facial wrinkles and defects report improvements lasting variable lengths of time--6 months to 3 years, or more. Plastic surgeons who do perform this procedure are careful to explain to patients the unpredictability of results and the probable need for repeated treatments. The transfer of large volumes of fat to other parts of the body is performed infrequently.
It is reasonable to expect that breast enlargement obtained by autologous fat injection would not be permanent and may make future detection of breast cancer difficult or impossible. The small number of proponents of this technique claim that, using their methods, mammography has not been impaired in the few patients who have undergone the procedure; however, it is well known that calcification often takes years to develop, and there is no way to predict that women undergoing breast enlargement by fat injection will not develop significant amounts of calcification in the future. Since calcification causes mammographic changes that may be virtually indistinguishable from those associated with breast cancer, these women very likely could require repeated biopsies to determine if cancer is present.
Any woman considering breast augmentation by fat injection must understand that this is an experimental procedure, and there is no reliable evidence that it is either safe or effective over a long period of time. While patients may certainly consent to undergo the procedure, they should be certain to have all the information necessary to make an informed decision. In addition, they should determine if the experimental trials have been approved by an Institutional Review Board, an independent body of physicians that reviews medical research for quality and validity while assuring that patients are informed and protected.
Given current restrictions on the availability of silicone gel-filled implants for breast augmentation, saline-filled breast implants are presently the best alternative for women who desire breast enlargement.