Friday, May 21, 2010

Relocating Those Lady Lumps ? We're Not Ready To Transfer Fat To The Breast.

Imagine it, fuller more rounded breasts without the hassle of breast implants. Being rid of unwanted fat around your tummy, waist and hips ! Why not !? The idea of transferring fat to other body areas is nothing new in plastic surgery, and it has been done for years.

But there has been hesitancy amongst plastic surgeons to adapt this technique to the breast, where fat grafts may interfere with mammography or even falsify the diagnosis of cancer. Enter the non-plastic surgeons.

I know of at least two physicians (neither of them board-certified plastic surgeons) who are transferring patients' own fat from the abdomen, hips, and thighs to create a fuller breast.

On the surface, this sounds great. And it may even look great. But it's beneath the surface where the real trouble may lie. A natural and expected part of fat transfer is loss of the fat cells. These cells are very fragile, and up to 60% of them do not survive. What happens to them next after they die is a not-so-benign process called fat necrosis. The oil from the released fat cells undergoes a process called saponification (those of you who remember science class remember that soap was made this way on Sapo Hill back in ancient times, hence the name !) This involves deposition of tiny flecks of calcium, which show up on mammograms.

This process results in changes that may be felt by the patient, but are definitely seen on a mammogram. The key here is the word "spectrum" because the calcifications sometimes have a very benign appearance, but other times may closely resemble breast cancer.

Let me quote a few lines from some recent scientific articles on that particular point (the links are below for those of you who want to read more):

"Although fat necrosis may mimic various manifestations of breast malignancy, needle localized biopsy and core biopsy have demonstrated this finding in only 1.9% and 2.5% of cases"

"The mammographic spectrum of fat necrosis ranges from clearly benign to indeterminate to malignant appearing masses or calcifications."

"Five cases are presented which illustrate the spectrum of mammographic features of traumatic fat necrosis. The appearances vary from one indistinguishable from carcinoma to
single or multiple lipid-filled cysts with or without calcified

So what this means is that fat necrosis, an expected outcome of fat grafting, can produce a whole host of changes in the breast. These are unpredictable and capricious, and mimic the nature of the fat grafting procedure itself. In the buttock, where fat transfer is frequently done, this is no problem. We have no buttock cancer epidemic in the U.S. and 1 in 9 women will not be affected by it like breast cancer.

Often, a biopsy will be recommended to sort the problem out. During that time, there will obviously be confusion, concern, and anxiety for all involved.

Finding out if fat transfer is safe in the breast will require that doctors enroll large numbers of patients in a research study, and follow their mammograms carefully for a number of years. Only then can we learn how prevalent fat necrosis actually is, what it looks like, and how best to treat it. To my knowledge, the practitioners advocating fat grafting at this time sadly have no intention of doing so.

Ultimately, stem cell techniques will allow a "cleaner" way to grow and manipulate tissues of the human body, including the breast. When that time comes, replacement tissues will be available to trauma and cancer patients, as well as those seeking cosmetic enhancement. Look for plastic surgeons to lead the way.