Breast augmentation with own fat – autoaugmentation

Recent years have seen a vast development of the use of patient’s own fat tissue for the purpose of augmentation at required areas. This method can now achieve effective and lasting results. Fat is a suitable filling material with optimal properties, which naturally integrates into tissues. It is autologous and therefore completely biocompatible.

At present, a number of possible ways of using this method are available in plastic surgery. The most frequent indications include breast augmentation and facial fat grafting (nasolabial folds, area of upper and lower eyelids, upper facial area, lips). When fat grafting is applied to cosmetic surgery in the facial area, the autologous tissue has a better effect than just a filling. It has a high regeneration capability for ageing skin and improves elasticity, firmness and overall quality. Excellent results are achieved by combining fat grafting and facelifting.

The main prerequisite for undergoing a breast augmentation surgery using patient’s own fat is a sufficient amount of fat tissues available at other locations. When considering fat grafting for the purpose of breast augmentation, it should be realized that this method can augment the breasts by up to 100 to 200 millilitres per session. Sessions can be repeated. Or, as the case may be, the BRAVA system can be used in order to perform breast augmentation by up to 300 millilitres.

The duration of intervention depends on the amount of fat applied. Normally the surgery takes from 30 minutes to 2.5 hours.

Collection of fat tissue: The collection technique is similar to that of classic liposuction for cosmetic purposes. The intervention can be performed under both general and local anaesthesia. In case of longer procedures, general anaesthesia is more appropriate with regard to patient’s comfort. The difference consists in the necessity of performing the liposuction intended for the transfer in the most careful manner in order to conserve fat cells. Special cannulas and a lower underpressure are used for the collection. The liposuction area is selected together with the patient in order to assure a cosmetically favourable effect of liposuction. In women, hips, outer thighs and abdomen are most frequently used. If necessary, we can also perform liposuction from calves, knees, inner thighs and the gluteal area.

Processing of fat tissue: The collection of fat tissue is followed by its cleaning. Several different methods exist for this stage, each having its advantages and drawbacks. Probably the most popular method for cleaning of fat tissue is its centrifugation. The central layer of sediment generated in this way is used for application, as it contains the biggest amount of living fat cells, as well as a large amount of root cells and various intracellular mediators. Cleaning can be also performed using special Puregraft membrane bags, in which the suctioned fat is washed with a Ringer solution and then drawn directly into the application syringes.

Applications of fat: An appropriate technique of application is the key factor of the overall process. Fat tissue must be applied in so-called “microbeads” into multiple tissue layers in order to provide for a sufficient nourishment of the injected cells. Small dimensions of the applied beads and their distribution over a large area should guarantee a sufficient contact with the surrounding tissues and therefore a proper supply of blood. By adhering to this procedure, we fulfil the essential requirements for long lasting results of the intervention.

BRAVA system used for breast augmentation

The BRAVA system was originally developed for the purpose of short term breast augmentation. The system worn as a bra consists of two domes with soft silicon edges and a small underpressure pump.

With regard to the necessity of a long term application of this system during the perioperative period and an absolute necessity of compliance, the use of BRAVA requires a well informed and motivated patient, from whom an excellent cooperation is expected.

How this system works? When used during 3 weeks before fat grafting, breast is augmented up to three times merely as a result of the underpressure applied. However, without fat grafting, this effect is just temporary. When external underpressure is applied, breast expansion is accompanied by creating new blood vessels. In this way, an enlargement of a well perfused space ready for fat grafting is generated, and therefore a larger amount of microbeads can be injected. A rule applies that the larger the pre-surgery expansion, the larger is the potential augmentation.

Before surgery, the patients should normally wear the system for 3 weeks, however, more important than the duration of this period is the achieved volume expansion. Some patients expand faster, others slower. A BRAVA pre-expansion tends to be more difficult for patients possessing small, firm breasts. They need to use a higher underpressure and sometimes a “double bubble” deformity may develop as a result of an unbalanced expansion between the periareolar area and the rest of the breast. It is necessary that the patients do not stop expansion at the moment the desired breast size is achieved. It is advisable to overexpand the breast to a certain extent in order to obtain a sufficient “envelope” for application of fat.
When this system is used together with fat grafting, the breasts can be augmented by up to 300 millilitres during one session. Following the surgery, the patients wear BRAVA 24 hours a day for 3 days. Subsequently, 12 hours a day are required for at least 4, ideally 8 weeks. Also longer periods are possible, leading to still better results. Most women prefer wearing BRAVA at night.

The final result of fat grafting is not perceptible sooner than three month after the intervention. The lasting regeneration effect consisting in an improved quality of skin starts to become manifest around one year after surgery.

How to prevent complications after fat grafting

Following an appropriately performed fat grafting, complications are very rare. In particular in the facial area, pronounced swellings may occur, attaining a maximum around the third day after surgery. Swellings can be reduced by cooling the treated areas during the first days after the intervention. However, some authors describe a reduction of perfusion accompanying such cooling, which has a negative impact on the acceptance of transferred fat cells.

Other complications that can be encountered include unevenness in the area of liposuction, as well as asymmetry and insufficient or, on the contrary, excessive filling. Oil cysts may result from the “microbead” technique not being strictly observed. Another possible, but extremely rare complication is embolization of fat after its application into the vessel using sharp cannulas. Potential asymmetry or insufficient filling is not necessarily caused by a technical mistake, but rather by the fact that the ratio between the accepted and absorbed material is not fully predictable.