Fat Transfer Question and Answer

Why can’t ladies with large implants and little breast tissue have explant and fat transfer in one procedure? How long do these patients have to wait in between procedures?

Answer: Because it is harder to transplant the fat since there is not enough recipient tissue. One more factor is that the larger the implant the larger the remaining pocket, so the more likely the fat will end up in the pocket and not in the tissues where it is needed to survive.  Also important to note, the ladies with small breast tissue and large implants who are not the best candidates to do a fat transfer usually need a drain.  One important thing to clarify is that the fat transfer can always be performed, but the chances of it not being successful are higher. If the fat transfer is not performed in a single time it is best to wait 6 months.

How much swelling is predicted after en bloc/fat transfer and/or lift?

Answer: Around 15-20%.  This varies from patient to patient, some swell more some others might not swell.

What is the expected percentage of fat loss?

Answer: Around 50%.  Again, this varies from patient to patient.  Some patients don’t lose any fat while some others might lose it all. It also depends on the use of PRP and hyperbaric chamber.

At what month can we expect that fat loss will not occur any more?

Answer: It should be 100% stable after the first month, although there might be some extra volume due to swelling. Swelling can last a few months on some patients.

What is the max amount of CCs that you can put into each breast?

Answer: This depends on the size of the breast.  The more recipient tissue available the more volume I can inject. For example:  A woman with large breasts has more breast tissue available so I can inject more fat.

Are there any benefits of doing more than 3 hyperbaric oxygen chamber sessions? At what time frame are they no longer beneficial to fat survival?

Answer:  Yes there are, actually the faster these treatments are started and the more they are performed especially in the first 15 days the better. This is why we recommend starting the HBOT sessions the first day after surgery. This not only helps for fat survive, but also for faster healing of the surgical wounds which helps prevent infection.  A minimum of 3 is required.  They are no longer beneficial after a month.

Please explain calcifications, oil cysts and fat necrosis.

Answer: Fat necrosis is the medical term to describe dead fat cells, calcifications are the result of fat necrosis and oil cysts are fat emulsification, which is seen by the body as something to isolate, so a capsule is formed around it. These fat cysts are easily extracted with a 5 minute procedure using a needle to aspirate them and they have no clinical relevance. Every woman who has a fat transfer will have calcifications in higher or lesser degree depending on the fat survival. Every woman develops calcifications because it’s part of the normal ageing process. Some calcifications, depending on their size and ethiology will be reabsorbed by the body some others will not.  A diet high in magnesium will help this process.

Many things can produce breast calcifications; among these are improper assimilation of calcium, breast injury, cysts, fibroadenomas (benign breast tumor), dermal or vascular calcifications, and fat necrosis and of course breast cancer.  The important thing is to understand that these are easy to tell apart and that the macrocalcifications pose NO CLINICAL RELEVANCE or possibility to produce disease.

There are two types of calcifications:

1. Macrocalcifications:  These are coarse calcium deposits that you can see in the mammograms as large white dots.  Macrocalcifications are associated with women over 40 and almost every woman has a macrocalficication after 50.  They are HARMLESS and are a part of the normal aging process of the breast.  These are the calcifications produced by fat necrosis.

2.  Microcalcifications:  These are tiny calcium deposits that appear with little white dots and although most of the time are not linked to cancer, these are the ones we have to look after because they can be a sign of breast cancer.

Please explain how fat transfer effects mammograms.

Answer: The fat necrosis calcifications will be seen in a mammogram.  According to several radiologists consulted, they are not a problem in the diagnosis of breast cancer, since fat necrosis calcifications are very different in size and shape to the ones produced by cancer.

It is important to add that most women over 40 have calcium deposits (calcifications) in their breasts, and most of them are benign. It’s part of the aging process of the tissue. These can show up as white spots on a mammogram—they tend to be harmless, if they’re large, coarse, solitary spots but they become suspicious if the tiny flecks cluster together in a linear pattern. Most radiologists can distinguish between the two, and only the suspicious ones warrant a biopsy.

Fat necrosis calcifications are very easy to distinguish because they are very large.  One of the consulted radiologists mentioned that not distinguishing between a cancer calcification and a fat necrosis calcification would be like not distinguishing between a dog and a tree.

Please explain how Platelet Rich Plasma helps prevent fat loss.

Answer: Platelet Rich Plasma, or PRP, is a fraction of your own blood drawn off and spun down and then reapplied or injected to create improved tissue health.

Platelets are very small cells in your blood that are involved in the clotting process. As they are organized in the clot they release a number of enzymes and growth factors to promote healing and tissue responses including attracting stem cells to repair the damaged area and time-damaged tissue that can induce a remodeling of the tissue to a more healthy and younger state.

These specific components in blood include platelet derived growth factor (PDGF) and transforming growth factor beta (TGFß), both of which are contained within the alpha granules of platelets, and fibronectin and vitronetin, which are cell adhesion molecules found in plasma, and fibrin itself. These factors induce the formation of endothelial cells needed for the creation of blood vessels and fibroblasts needed for the mesh where the fat cells thrive.  Another important thing is that they are involved in the activation of mesenchymal stem cells which everyone has in their fat (10 per cc) and they have amazing healing capability.

How much fat is needed for fat transfer?

Answer: Enough to accomplish the desired volume. Volume will depend on fat availability and quantity of recipient tissue where the fat can be injected.

Can you perform fat grafting on mastectomy patients? If so what is the criteria?

Answer:  This is actually how I started doing fat grafting to the breasts. I had my breast surgery training in the European Institute of Oncology, Milano, Italy.  This center has been the flagship for breast cancer treatment/reconstruction world wide for many years, it was in this center that a conservative approach to breast cancer (gold standard now a days) was invented as well as the nipple sparing, skin sparing, one single time reconstruction amongst other top cancer treatments. Patients who desire reconstruction with fat transfer need to be clear of breast cancer.  It is harder for fat to survive on patients who have had radiation, but by the same token, radiodermitis (complication of the skin derived from radiotherapy) improves amazingly with the fat transfers.

What are the chances of one breast losing more fat than the other?

Answer: It is impossible to predict this, but it is very rare.  Same surgeon, same fat, same PRP concentration, same application technique, same volume, same individual. For some time one breast may be smaller than the other due to swelling.

Can mastectomy patients get fat grafting with explant and lift at the same time?

Answer:  Each case should be evaluated individually, but yes it can be done.

How does any future weight loss affect the fat transferred into the breast?

Answer:  Fat will behave as it normally does in any other part of the body.  Breasts are composed of glandular tissue and fat tissue, healthy women who have never had any surgery will lose breast volume if they lose weight, so expect to have these changes apply to any fat transfer.  The one important thing to point out is that as most women have probably noticed there are some areas of the body with more “stubborn” fat, such as the love handles or lateral thighs.  This is due to less receptors in the membranes of these particular fat cells, which make them more resilient to releasing their fat.  This is the fat that I prefer to graft and transfer, since it is less prone to be affected by weight changes.

Is it too much trauma to have explant and fat transfer at the same time if your body is already stressed with auto immune and health issues?

Answer:  As a matter of fact the more surgery that is performed the more trauma your body will have.  It is important to evaluate each case to verify if a patient qualifies for surgery and if it is safe to do it.  If the medical condition of the patients allows me to perform the surgery I will do it, but if I have the smallest doubt then we will discuss if we can do it at the same time or do it in separate procedure.  This applies to every surgery.

Can I do explant and lift only and then come back for lipo and fat transfer after some time?   Will the lift make the skin too tight to have good results?

Answer: Yes, but you will need to wait 6 months. A previous lift will not alter the results.

What is the longest amount of time that you are aware of that a woman has retained the fat in the breast?

Answer:  Once the fat survives the transplantation process it stays living in its new home as any other cell would.

How long have you been doing fat transfer?

Answer:  Since I did my fellowship in IEO in 2005 for breast reconstruction.  For aesthetic purposes, 9 years.

Is there anything we should avoid doing or taking as far as medications that will alter fat transfer success?

Answer: Following our medical directions and strictly adhering to our treatment protocol is the best thing that can be done to avoid having a complication and having the best chances to obtain a better result.  Every medical indication, therapeutic indication or prescription drug administered has a very important role in your safety and better outcome of your surgery.  Neglecting them, not following directions or not taking the prescription drugs recommended might not only have a negative impact on a good outcome, but also pose a serious hazard to your health.

Is there anything we can do to help the fat stay or decrease the amount loss?

Answer:  Hyperbaric treatments after surgery and staying hydrated.

From your experience, have you determined certain circumstances that may lead to fat loss in the patient? For example, do women with little breast tissue or very small natural breasts retain less of the fat?

Answer:  Not following directions, not doing the hyperbaric treatment, very old age, very large volume transfers, smoking (Not candidates), exposure to second hand smoke, anemia, exercising too quickly, extreme stress and little recipient breast tissue are the main factors.

Due to religion some patients decide not to accept the PRP use and this also has an impact.

If we get fat transfer, will we be able to gain weight back to the lipo site(s) or does it stay gone?

Answer:  Yes you can gain weight again.  There will be a lower adipocyte (fat cells) population in the areas treated with liposuction, so fat gain there will probably be slower, but the body will for sure look for a place to store the extra food we eat if we do not burn with exercise.

What is recovery time for lipo areas? And how long will one have to wear compression garments?

Answer:  Full recovery time after a liposuction is 6 months, although you will see important results within the first months.  It will take the lymphatic system (drainage system of the body) 6 months to fully restore the drainage of our tissues after a liposuction.  I recommend the compression garments and bra for one month and as many lymphatic drainage massages performed by qualified therapists as possible.

Will lipo area aesthetics be affected if a patient loses further weight after liposuction? (In other words will patient expect to have bumps or uneven texture show up if they lose more weight (significant) after lipo? Or should they achieve their target weight before lipo/fat transfer to have good lipo results?

Answer:  Liposuctions like any other surgery has bad results for several reasons, among the most frequent ones are:

1. Bad indication.  When a liposuction is performed in an area where the skin is too stretched or where very little fat tissue is present.

2. Previous liposuctions.  The more liposuctions you have had in an area the higher the possibility of you developing scaring, which is impossible to avoid and will produce lumps and bumps.

3. YOYO effect.  When patients after a liposuction gain and lose weight constantly.

4. Post op care.  When patients choose not to use the compression garments or get lymphatic drainage massages.

I would like to get a lift and fat transfer but I am planning to have a baby soon. Should I wait for lift and fat transfer after I have had a baby? 

Answer:  Yes, it is best to have your baby and then surgery.  A pregnancy will compromise the results obtained with surgery.

Will “new” fat have the same lasting result as fat that we have had for a while?

Answer: Yes they behave exactly in the same way.

What is your opinion about the brava device?

Answer: It works if you are a good candidate. However, it takes considerable patient effort and time. You have to wear the device for several weeks to months (all day long – including to work or whatever you do during the day since the skin will only expand with continuous negative pressure). Also, the best results I have seen are when the Brava is combined with fat grafting once the breast is distended with the system.  It is a possibility for a very committed patient.

How long will I be out of work if my job has physical requirements such as a nurse who has to lift patients?

Answer:  One month.