One of the latest innovations in plastic surgery is the evolution of fat grafting, which uses the patient's fat to enhance other areas of the body, such as breasts. In January 2010, the Food and Drug Administration granted Cytori Therapeutics 510(k) marketing clearance for its PureGraft System, the first device in the United States cleared for aesthetic body contouring using autologous fat.

Lawrence Koplin, a Beverly Hills plastic surgeon is using the device as part of his dual-process fat-grafting method. Koplin collects fat via a Dean Medical Instruments (Huntington Beach, CA) liposuction machine set at the lowest possible negative pressure to prevent injury to the fat cells. The fat is suctioned to a sterile Luken's Trap which holds about 50cc (just under 3 tablespoons) of fat. This prevents the sustained exposure of the fat to vacuum suction, and allows quick removal from the extraction system.

Koplin then gently washes the fat in Lactated Ringer's solution to remove blood particles and excess oily material. The Lactated Ringer's solution differs from water and saline in that it has the same make-up and acidity as blood and fat. After washing and removal of the solution, Koplin is left with pure yellow healthy fat. He then uses a Thermo Scientific Medilite Micro Centrifuge to concentrate a stem cell-rich portion in the lowest 20% of the syringe. This “privileged” fat is the state-of-the-art preparation currently approved for use by the FDA. Koplin injects the fat using special manufactured, extremely delicate Tulip needles that are coated with silicone on the inner surface. All these steps are designed to treat the fat as delicately as possible in order to prevent injury to the cells. The fat with the highest concentration of stem cells is ideal as stem cells are known to promote healing and increase blood vessel ingrowth, making survival of the fat cells much more likely.

There are three general categories of fat grafting to the breast:

  • Autologous

    This concept makes it possible to enlarge the breast without using an implant. This is called autologous fat transfer. Fat is extracted from the body using liposuction and it is injected into the breast after processing. Koplin refers to this as “Robin Hood” surgery, as both the donor and recipient areas benefit from the procedure. There are limitations with this procedure as some women do not have enough fat to donate, and realistic goals limit the enlargement to approximately one cup size. This procedure is not recommended for women who have a strong family history of breast cancer as slight abnormalities in the mammogram may occur.

  • Past mastectomies or lumpectomies

    The second category of women who are candidates for breast enhancement using fat transfer are women who have had mastectomies or lumpectomies. Lumpectomies are becoming increasingly popular as the procedure only removes the cancerous portion of the breast, leaving healthy issue intact; the remaining tissue is then sterilized by radiation therapy. With this procedure the defect cannot be corrected with an implant because only a portion of the breast has been removed (an implant is designed to fill the entire breast). A breast that has undergone lumpectomy is the ideal site for a fat-transfer reconstruction. The deformity can be aesthetically repaired by the exact amount and configuration of fat transfer required. The stem cells in the fat will signal blood vessels to grow, softening the area as well as improving skin color and texture.

  • Fat grafting in conjunction with implants

    The third category combines fat grafting with breast implants. Koplin believes this may be the most exciting development in cosmetic breast surgery since the development of the breast implant in 1962. Many women complain that their implants are rippled, are visible or palpable, or do not go far enough toward the midline of the chest to create proper cleavage. Fat transfer can powerfully improve all of these concerns with minimal surgery. Fat grafting can be used to narrow the separation between the implants and bring the cleavage closer together. Women who have a deep breast bone can diminish the hollow between the breasts and have their chest look less skeletal. Koplin also uses the fat transfer technique to thicken the tissues between the skin and the implant so that ripples and visible edges of the implants are erased. Some experts claim that for implants that have become hard, the stem-cell rich fat seems to bring new blood vessels to the area, which nourish the scar tissue around the implant to make them softer.