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J Cosmet Med 2023; 7(2): 71-76

Published online December 31, 2023

https://doi.org/10.25056/JCM.2023.7.2.71

Strategies to perform autologous fat grafting for breast augmentation in underweight women

Cheng-Hung Chiu , MD

Department of Plastic and Aesthetic Surgery, Genesis Clinic, Taipei, Taiwan

Correspondence to :
Cheng-Hung Chiu
E-mail: chiuokclinic@gmail.com

Received: May 25, 2023; Revised: July 3, 2023; Accepted: July 10, 2023

© Korean Society of Korean Cosmetic Surgery & Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Breast augmentation is the most common surgical intervention among women. However, concerns persist regarding the use of autologous fat grafting for breast augmentation in underweight females.
Objective: This retrospective study aimed to evaluate the efficacy and safety of autologous fat grafting in breast augmentation for underweight females (body mass index [BMI] <18.5 kg/m2).
Methods: This study included 53 underweight patients who underwent autologous fat grafting for breast augmentation. Standardized protocols were followed, and comprehensive data regarding post-treatment complications were recorded. Volumetric and subjective evaluations were conducted to assess outcomes.
Results: The average age of the patients was 31.6 years, with an average BMI of 17.7 kg/m2 and body fat percentage of 21.4%. The average volume of aspirates obtained was 1,410 ml, and each breast received an average injection volume of 295 ml fat. Routine postoperative assessments revealed fat necrosis of 3.7%. The mean volume retention of the grafted fat was 69.9% at the one-year mark, and the overall patient satisfaction rate was 94.3%.
Conclusion: Autologous fat grafting can be challenging in underweight women because of limited fat reserves and tight breast skin. Strategies such as ultrasound-assisted liposuction and precise injection techniques can overcome these challenges. The study suggests that a BMI <18.5 kg/m2 is not a contraindication for autologous fat grafting in breast augmentation. Autologous fat grafting can be effective and safe for breast augmentation in underweight women, with satisfactory results and minimal complications.

Keywords: autologous fat grafting, breast augmentation, efficacy, patient satisfaction, safety, underweight women

Fig. 1.Preoperative and postoperative breast volumes were assessed utilizing a noncontact three-dimensional (3D) laser scanner (Minolta Vivid 910 3D Digitizer; Konica Minolta Inc., Tokyo, Japan) equipped with a customized portable device (A). The 3D laser scanner captured the breast surface, generating a merged 3D image for each patient (B).
  1. International Society of Aesthetic Plastic Surgery (ISAPS). ISAPS international survey on aesthetic/cosmetic procedures performed in 2021 [Internet]. Mount Royal (NJ): ISAPS; c2021 [cited 2023 May 24].
    Available from: https://www.isaps.org/media/vdpdanke/isaps-global-survey_2021.pdf
  2. Delay E, Delpierre J, Sinna R, Chekaroua K. [How to improve breast implant reconstructions?] Ann Chir Plast Esthet 2005;50:582-94. French.
    Pubmed CrossRef
  3. Missana MC, Laurent I, Barreau L, Balleyguier C. Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol 2007;33:685-90.
    Pubmed CrossRef
  4. Zheng DN, Li QF, Lei H, Zheng SW, Xie YZ, Xu QH, et al. Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg 2008;61:792-8.
    Pubmed CrossRef
  5. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861-7.
    Pubmed CrossRef
  6. Chiu CH. A “solid injection method” to reduce postoperative complications in autologous fat grafting for breast augmentation. Am J Cosmet Surg 2013;30:10-5.
    CrossRef
  7. Chiu CH. Autologous fat grafting for breast augmentation in underweight women. Aesthet Surg J 2014;34:1066-82.
    Pubmed CrossRef
  8. Chiu CH. Does stromal vascular fraction ensure a higher survival in autologous fat grafting for breast augmentation? A volumetric study using 3-dimensional laser scanning. Aesthet Surg J 2019;39:41-52.
    Pubmed CrossRef
  9. Chiu LC, Chiu LS, Chiu CH. Reconsidering cell-assisted lipotransfer for breast augmentation: effect of stromal vascular fraction enrichment on graft survival assessed with 3-dimensional laser scanning. J Cosmet Med 2019;3:25-32.
    CrossRef
  10. Pasco JA, Holloway KL, Dobbins AG, Kotowicz MA, Williams LJ, Brennan SL. Body mass index and measures of body fat for defining obesity and underweight: a cross-sectional, population-based study. BMC Obes 2014;1:9.
    Pubmed KoreaMed CrossRef
  11. Voglimacci M, Garrido I, Mojallal A, Vaysse C, Bertheuil N, Michot A, et al. Autologous fat grafting for cosmetic breast augmentation: a systematic review. Aesthet Surg J 2015;35: 378-93.
    Pubmed CrossRef
  12. Duhoux A, Chennoufi M, Lantieri L, Hivelin M. Complications of fat grafts growth after weight gain: report of a severe diplopia. J Plast Reconstr Aesthet Surg 2013;66:987-90.
    Pubmed CrossRef
  13. Tran BNN, Didzbalis CJ, Chen T, Shulzhenko NO, Asaadi M. Safety and efficacy of third-generation ultrasound-assisted liposuction: a series of 261 cases. Aesthetic Plast Surg 2022; 46:2310-8.
    Pubmed CrossRef
  14. Fisher C, Grahovac TL, Schafer ME, Shippert RD, Marra KG, Rubin JP. Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 2013;132:351-61.
    Pubmed CrossRef
  15. Schafer ME, Hicok KC, Mills DC, Cohen SR, Chao JJ. Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J 2013;33:698-704.
    Pubmed CrossRef
  16. Schlenz I, Kaider A. The brava external tissue expander: is breast enlargement without surgery a reality? Plast Reconstr Surg 2007;120:1680-9.
    Pubmed CrossRef
  17. Del Vecchio D. Breast reconstruction for breast asymmetry using recipient site pre-expansion and autologous fat grafting: a case report. Ann Plast Surg 2009;62:523-7.
    Pubmed CrossRef
  18. Khouri RK, Eisenmann-Klein M, Cardoso E, Cooley BC, Kacher D, Gombos E, et al. Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg 2012;129:1173-87.
    Pubmed CrossRef
  19. Uda H, Tomioka YK, Sugawara Y, Sarukawa S, Sunaga A. Shaping of the unaffected breast with brava-assisted autologous fat grafting to obtain symmetry after breast reconstruction. Aesthet Surg J 2015;35:565-73.
    Pubmed KoreaMed CrossRef
  20. Cohen WA, Mundy LR, Ballard TN, Klassen A, Cano SJ, Browne J, et al. The BREAST-Q in surgical research: a review of the literature 2009-2015. J Plast Reconstr Aesthet Surg 2016;69:149-62.
    Pubmed KoreaMed CrossRef

Article

Original Article

J Cosmet Med 2023; 7(2): 71-76

Published online December 31, 2023 https://doi.org/10.25056/JCM.2023.7.2.71

Copyright © Korean Society of Korean Cosmetic Surgery & Medicine.

Strategies to perform autologous fat grafting for breast augmentation in underweight women

Cheng-Hung Chiu , MD

Department of Plastic and Aesthetic Surgery, Genesis Clinic, Taipei, Taiwan

Correspondence to:Cheng-Hung Chiu
E-mail: chiuokclinic@gmail.com

Received: May 25, 2023; Revised: July 3, 2023; Accepted: July 10, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Breast augmentation is the most common surgical intervention among women. However, concerns persist regarding the use of autologous fat grafting for breast augmentation in underweight females.
Objective: This retrospective study aimed to evaluate the efficacy and safety of autologous fat grafting in breast augmentation for underweight females (body mass index [BMI] <18.5 kg/m2).
Methods: This study included 53 underweight patients who underwent autologous fat grafting for breast augmentation. Standardized protocols were followed, and comprehensive data regarding post-treatment complications were recorded. Volumetric and subjective evaluations were conducted to assess outcomes.
Results: The average age of the patients was 31.6 years, with an average BMI of 17.7 kg/m2 and body fat percentage of 21.4%. The average volume of aspirates obtained was 1,410 ml, and each breast received an average injection volume of 295 ml fat. Routine postoperative assessments revealed fat necrosis of 3.7%. The mean volume retention of the grafted fat was 69.9% at the one-year mark, and the overall patient satisfaction rate was 94.3%.
Conclusion: Autologous fat grafting can be challenging in underweight women because of limited fat reserves and tight breast skin. Strategies such as ultrasound-assisted liposuction and precise injection techniques can overcome these challenges. The study suggests that a BMI <18.5 kg/m2 is not a contraindication for autologous fat grafting in breast augmentation. Autologous fat grafting can be effective and safe for breast augmentation in underweight women, with satisfactory results and minimal complications.

Keywords: autologous fat grafting, breast augmentation, efficacy, patient satisfaction, safety, underweight women

Fig 1.

Figure 1.Preoperative and postoperative breast volumes were assessed utilizing a noncontact three-dimensional (3D) laser scanner (Minolta Vivid 910 3D Digitizer; Konica Minolta Inc., Tokyo, Japan) equipped with a customized portable device (A). The 3D laser scanner captured the breast surface, generating a merged 3D image for each patient (B).
Journal of Cosmetic Medicine 2023; 7: 71-76https://doi.org/10.25056/JCM.2023.7.2.71

References

  1. International Society of Aesthetic Plastic Surgery (ISAPS). ISAPS international survey on aesthetic/cosmetic procedures performed in 2021 [Internet]. Mount Royal (NJ): ISAPS; c2021 [cited 2023 May 24]. Available from: https://www.isaps.org/media/vdpdanke/isaps-global-survey_2021.pdf
  2. Delay E, Delpierre J, Sinna R, Chekaroua K. [How to improve breast implant reconstructions?] Ann Chir Plast Esthet 2005;50:582-94. French.
    Pubmed CrossRef
  3. Missana MC, Laurent I, Barreau L, Balleyguier C. Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol 2007;33:685-90.
    Pubmed CrossRef
  4. Zheng DN, Li QF, Lei H, Zheng SW, Xie YZ, Xu QH, et al. Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg 2008;61:792-8.
    Pubmed CrossRef
  5. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861-7.
    Pubmed CrossRef
  6. Chiu CH. A “solid injection method” to reduce postoperative complications in autologous fat grafting for breast augmentation. Am J Cosmet Surg 2013;30:10-5.
    CrossRef
  7. Chiu CH. Autologous fat grafting for breast augmentation in underweight women. Aesthet Surg J 2014;34:1066-82.
    Pubmed CrossRef
  8. Chiu CH. Does stromal vascular fraction ensure a higher survival in autologous fat grafting for breast augmentation? A volumetric study using 3-dimensional laser scanning. Aesthet Surg J 2019;39:41-52.
    Pubmed CrossRef
  9. Chiu LC, Chiu LS, Chiu CH. Reconsidering cell-assisted lipotransfer for breast augmentation: effect of stromal vascular fraction enrichment on graft survival assessed with 3-dimensional laser scanning. J Cosmet Med 2019;3:25-32.
    CrossRef
  10. Pasco JA, Holloway KL, Dobbins AG, Kotowicz MA, Williams LJ, Brennan SL. Body mass index and measures of body fat for defining obesity and underweight: a cross-sectional, population-based study. BMC Obes 2014;1:9.
    Pubmed KoreaMed CrossRef
  11. Voglimacci M, Garrido I, Mojallal A, Vaysse C, Bertheuil N, Michot A, et al. Autologous fat grafting for cosmetic breast augmentation: a systematic review. Aesthet Surg J 2015;35: 378-93.
    Pubmed CrossRef
  12. Duhoux A, Chennoufi M, Lantieri L, Hivelin M. Complications of fat grafts growth after weight gain: report of a severe diplopia. J Plast Reconstr Aesthet Surg 2013;66:987-90.
    Pubmed CrossRef
  13. Tran BNN, Didzbalis CJ, Chen T, Shulzhenko NO, Asaadi M. Safety and efficacy of third-generation ultrasound-assisted liposuction: a series of 261 cases. Aesthetic Plast Surg 2022; 46:2310-8.
    Pubmed CrossRef
  14. Fisher C, Grahovac TL, Schafer ME, Shippert RD, Marra KG, Rubin JP. Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 2013;132:351-61.
    Pubmed CrossRef
  15. Schafer ME, Hicok KC, Mills DC, Cohen SR, Chao JJ. Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J 2013;33:698-704.
    Pubmed CrossRef
  16. Schlenz I, Kaider A. The brava external tissue expander: is breast enlargement without surgery a reality? Plast Reconstr Surg 2007;120:1680-9.
    Pubmed CrossRef
  17. Del Vecchio D. Breast reconstruction for breast asymmetry using recipient site pre-expansion and autologous fat grafting: a case report. Ann Plast Surg 2009;62:523-7.
    Pubmed CrossRef
  18. Khouri RK, Eisenmann-Klein M, Cardoso E, Cooley BC, Kacher D, Gombos E, et al. Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg 2012;129:1173-87.
    Pubmed CrossRef
  19. Uda H, Tomioka YK, Sugawara Y, Sarukawa S, Sunaga A. Shaping of the unaffected breast with brava-assisted autologous fat grafting to obtain symmetry after breast reconstruction. Aesthet Surg J 2015;35:565-73.
    Pubmed KoreaMed CrossRef
  20. Cohen WA, Mundy LR, Ballard TN, Klassen A, Cano SJ, Browne J, et al. The BREAST-Q in surgical research: a review of the literature 2009-2015. J Plast Reconstr Aesthet Surg 2016;69:149-62.
    Pubmed KoreaMed CrossRef

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