Looking Beyond the Implant

Alternative augmentation options like fat grafting aren’t winning any gold medals for augmentation popularity – yet. Fat grafting is coming in as a steady bronze, though, and the procedure is gaining momentum as more and more advancements are made to allow for ease of fat graft, subsequent healing and desired result.

In the world of breast implant options, silicone and saline reign supreme, and plastic surgeons will tell you that those implants are the norm. Shoved under the muscle or over, though, these implants carry with them the risk of breast implant illness. As foreign invaders of the body, they are viewed by the immune system as intruders – and often treated as such. Breast implant illness (BII) can present with a staggering variety of symptoms.

But what happens when the augmentation literally comes from a person’s own body? Is fat grafting safe – and is it a worthwhile alternative? Welcome to alternative augmentation – also known as fat grafting. The procedure has the potential to gain a much wider allure. After all, it sounds like a winning proposition: how many women have pointed to a particularly flabby part of the body, gestured to their breast area, and remarked, ‘Why can’t I have more of THIS….HERE?’ The short answer is….they can.

Such a transplant is possible. It’s happening. But it’s not foolproof. Let’s investigate the process of fat grafting, the efficacy of the operation and what makes a person a likely candidate for this alternative augmentation. 

Additionally, the FDA’s take on fat grafting, and some of the latest technologies available, are found here.

How it Works

Fat grafting isn’t as simple as extracting fat and inserting it in the more-desired area. If that were the case, we wouldn’t have so many women opting for silicone and saline implants – and the cases of breast implant illness would be nonexistent. Fat grafting is an involved process that really is just that – a process. It begins with local anesthesia and the subsequent extraction of the fat during harvest.

Yes, that’s what sucking fat out of a part of the body is called: harvest. And it’s done through liposuction. There are different means of achieving this liposuction, including ultrasound-assisted liposuction, water-assisted liposuction or laser liposuction. This procedure can result in swelling or bruising of the area for a few days afterward.

After the fat is removed from the body, it’s injected into the breast area. Fat grafting has come a long way since the ‘remove it-inject it-and hope for the best’ days. Cytori Therapeutics Puregraft System, for example, takes this fat (called autologous fat because it comes from the patient’s own body) and injects it in small amounts throughout multiple layers of breast tissue. Doing so makes it possible for the surgeon to mold the breast. Like a sculptor, they form the desired chest mound.

For those who have enough breast tissue to begin with, the pain can end there. However, many who opt for this augmentation will need to have tissue expanders. These can be uncomfortable, as they basically yank the breast tissue in a steady manner in order to ‘make room’ for the augmentation. The BRAVA device is one such expander and using it has been shown to allow for potentially larger cup sizes. In many cases, a patient undergoing fat graft can expect to gain no more than one cup size.

How Successful is it?

That depends on how you measure success in breast augmentation. For those looking to skyrocket their cup size, it’s going to be a disappointment. Fat grafting as it is at this point in time is not going to increase cup size in a dramatic way. This procedure carries with it much of the possible drawbacks of the saline and silicone implants as well. Just as with saline and silicone, asymmetry may occur. That means one breast may appear different than the other – a true ‘odd couple’ scenario.

Infection can happen, as it can with any medical procedure. And in the case of fat grafting, that precious fat that has been so carefully placed in a different area of the body can decide not to stay there. Fat migration happens when the fat moves from the desired spot. The liposuction itself can cause problems, including infection or anesthesia reaction.

Here’s the good news: it’s likely that the body will not reject the fat. After all, it is the patient’s own fat, not some foreign silicone or saline implant that the body works to expel. This is the whole impetus behind breast implant illness. Breast implant illness (BII) can result in immune disorders, depression, weight gain, and many more maladies. For those looking to avoid the risk and side effects of BII, fat grafting is a real alternative. 

Who is a likely candidate for fat grafting?

Someone with pockets deep enough to afford it, for starters. At this time, fat grafting is much more expensive than silicone or saline implants. It’s at least a two-part operation, and the costs quickly mount. From the liposuction to the possible expanders to the injection, the price tag can really increase quickly. 

Currently, fat grafting is favored by those who experience irregularities in their silicone or saline-augmented breasts because the fat can have a smoothing effect. Those seeking reconstruction may opt for fat grafting, yes, but must keep in mind that the end result will be a small breast.

As silicone and saline implants continue to be exposed for their role in adverse health outcomes, it stands to reason that the fat grafting technique will be improved. Whether the operation is worth the outcome is a personal decision that each patient must make. The future of fat grafting is not certain. Will it be perfected to the point where it phases out the need for silicone and saline? At this time, that’s not known. What is known is that implanting with silicone and saline breast implants can lead to adverse health outcomes in some women.

The FDA has recognized this and asked that warning labels be clearly placed on breast implant products. This in itself is a large step toward raising awareness of the prevalence of BII. For years, women complained of strange health problems that arose after implantation. Now, BII is recognized by many as a real illness that can stem from breast augmentation with saline or silicone implants.

Textured silicone implants carry with them an even deeper malice. They have been linked to a specific cancer, anaplastic large-cell lymphoma. Researchers aren’t completely united on the reason for the cancer, but a popular theory is that because the textured implants adhere to the chest wall, the body’s immune system may respond in an adverse way.

Whether a woman develops cancer or not, silicone and saline implants pose a potential danger, says the FDA. Look for different techniques such as fat grafting to be honed and improved in the coming years. As more and more women share their stories of implant, sickness and explant, it stands to reason that other technologies will be harnessed in order to continue to form breasts for those who want them.

What else do I need to know about fat grafting?

If you’re really considering fat grafting as an alternative to silicone or saline breast implants, research. Since this article was posted, there may be new and improved methods available.

An Alternative Solution to Fat Grafting: Self-Acceptance

Arguments vary regarding whether breasts are a ‘want’ or a ‘need.’ The practical debater may argue that fat grafting is a real alternative to silicone and saline implants – but what about the less expensive option of self-acceptance and a padded bra? The psychological ramifications of small or non-existent breasts are real for some women, though, and the answer to change this isn’t straightforward. 

According to the Beautiful After Breast Cancer Foundation, Western society views the breasts as highly sexualized. Some women don’t seem to notice or care that their breasts are small; others are highly bothered by size. In a culture that views chest size as favorable, though, one might argue that a woman with small breasts is at a disadvantage. And of course, there is the argument that implants can help a woman heal psychologically after cancer. 

After cancer and mastectomy, the self-image of a woman can lead to feelings of unease. Who is a woman without her breasts? With only one breast? Is a lump of tissue truly what makes a woman female? The psychological impact of mastectomy can mean low body image for some. 

Still others suffer from Body Dysmorphic Disorder (BDD), a mental illness that causes one to be obsessive about the state of their appearance. Cosmetic surgeons see these people – and if the physicians evaluate them correctly, do not operate on them. Such individuals are advised to seek counseling.

Convincing women they don’t need ‘boob jobs’ is so much more than saying, ‘Look at the risks. It’s not worth the pain and suffering.’ It’s likely not all that helpful to declare, ‘You shouldn’t go through that fat grafting process. it’s costly and painful.’ Women have been enlisting doctors to implant foreign objects to increase breast size for many years.

But why? What does it mean to feel ‘like a woman – to be a woman?’ That is the overriding question clouding all of the debate over saline vs. silicone vs. fat grafting. Answering it is a different experience for each individual.