Are Fat Injections Safe for Breasts?

Oct. 22, 2008 -- 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.

Fat Injections for the Breast: What's Known?

Fat injections used to improve the contour of the breast after reconstruction typically involve small, limited areas, Adams says. Injections after reconstruction is "much more accepted" by physicians, he says, and many have done it for years.

Fat injections given to enhance the breast appearance after lumpectomy and radiation can help tissue damaged by radiation, says Sydney Coleman, MD, a New York City plastic surgeon who performs that technique and will discuss it at the meeting. The injections, he tells WebMD, can promote the growth of a blood supply in the breast area that received radiation and aid in reversing the effects of radiation damage.

Fat Injections: Task Force Findings

Among the task force conclusions, reached after its members reviewed 110 published studies and other data:

• Fat grafts may be considered for use in the breast for augmentation and reconstruction, as well as other sites (such as hands and face), but the techniques are not standardized and may vary from doctor to doctor.
• No specific recommendations about fat grafts for the breast can be made because of a lack of strong data.
• Reported complications (such as tissue death) suggest the technique has associated risks.
• No reports about increased risk of malignancy associated with fat grafts could be found.
• Fat injections may interfere with breast physical exams, but available data suggest they may not interfere with mammograms.
• Clinical studies are needed to look at safety and effectiveness of fat injections, as well as such factors as how long the fat will last.

The ASPS is expected to review the conclusions and decide whether to amend its 2007 statement, Gutowski says.

Fat Injections for Breasts: Trials

Recruitment is under way for at least two clinical trials, both listed on the federal clinical trials Web site.

One, led by Scott Spear, MD, chief of plastic surgery at Georgetown University Hospital in Washington, D.C., is seeking 20 women, aged 20 to 50, to undergo liposuction and fat grafting to augment their breasts.

Another, led by Roger Khouri, MD, a Miami plastic surgeon, will study augmentation with fat in combination with the use of the Brava system. The system includes semi-rigid domes worn over the breasts for several hours a day to induce breast tissue growth before the injections are done.

Fat Injections for Breasts: Perspective

Using fat grafts for augmentation "needs to be looked at in a credible, scientific way," says Adams, a participant in the fat injection panel.

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."