Friday, March 09, 2007

Fat grafting for breast augmentation

Out of all the fillers (collagen, hyaluronic acid, & other) we use in Plastic Surgery, perhaps nothing is as good as your own fat for augmenting soft tissue. It's used in nasolabial fold (the creases alongside your nose which deepen with age), around the eye, in the lips, for buttock augmentation, and to correct "dents" from liposuction. The problem has to do with success rates running below 50% by most estimates.

Manhattan Plastic Surgeon, Dr. Syd Coleman, is the undisputed "king of fat grafting" and uses it above and beyond the indications most of the rest of us will do. He has described very refined techniques and presents results that are not reproducible for mere mortals. An article in the recent Plastic & Reconstructive Surgery journal described a series of fat graft breast augmentation cases of Dr. Coleman's, an area that has been taboo for years over concerns of issues of mammography artifacts.

Back in 1987 the American Society of Plastic Surgery (ASPS)issued a stong position against this procedure. The ASPS has wisely issued a new strong caution with this. From the lovely, Roxanne Guy, MD, current President of ASPS:
“Patients considering breast augmentation need to know that fat grafting for this indication is not recommended at this time, unless one is part of an ongoing clinical research study. Even though fat grafting techniques have become more refined and breast cancer detection methods have become more sophisticated with time, creating a great deal of excitement about the potential of fat grafting, we simply need more data before we can recommend that this procedure be generally used to augment breasts.”

At a panel at one of our meetings on controversies in Plastic Surgery last week, fat grafting outside Internal Review Board oversite was described as "human experimentation". Despite a number of small series describing this in reconstructive surgery, I'd tend to agree that this kind of fat grafting is something a little ahead of the issues that need to be studied.

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