Tuesday, March 26, 2013


What is Fat Grafting?
Fat grafting or fat transfer consists of harvesting fat cells from one part of the body (abdomen, hips, etc) via liposuction and then injecting these fat cells into another part of the body (face, buttocks, hands, breasts). Fat grafting is a technique that has been around for a long time and is commonly used by most plastic surgeons in at least one or two avenues.

Fat Cells
What can Fat Grafting be used for?
Fat grafting can be used for both cosmetic and reconstruction surgery. We commonly use fat grafting as a means of facial rejuvenation, whether alone or in conjunction with a traditional face lift. In this way it works similarly to fillers by helping to give volume to places such as the nasolabial folds, marionette lines, cheeks and lips. Fat grafting is also used commonly to add volume to the buttocks or to help achieve the desired round shape of the buttocks. In our practice we also very commonly use fat grafting as part of our implant based breast reconstruction. We use fat to fill out the upper pole of the breast where there is naturally some concavity after a mastectomy.
 What are the risks of Fat Grafting?
Just like any other procedure that we perform, there are certain risks associated with fat grafting. Risks that exist for all of the surgeries we perform include infection, bleeding, poor scar formation, asymmetry and need for revision surgery. Specific to fat grafting, the biggest risk is that the fat may not "take". Some of the fat that is taken from one part of the body and injected into another part of the body may be absorbed by the body, may become liquified and form a cyst, may calcify or may produce scarring within the tissue. On average approximately 30-50% of the fat that is injected will "take" and be incorporated into the body as a living tissue. Usually by 6 months to 1 year from surgery it is apparent how much of the fat that was injected has survived and at this point whatever is there will most likely be permanent. Other risks include the risks associated with the harvesting of the fat such as a seroma (a collection of fluid), hematoma (a collection of blood) or a contour deformity.

There are things that can be done in order to prevent some of these complications. The most important thing you can do to decrease your risk of having a complication (and this is true of ANY cosmetic or reconstructive procedure) is to make sure that you are going to a Board Certified Plastic Surgeon for the procedure. There are many Physicians out there performing cosmetic procedures, liposuction being a very common one, who are NOT Board Certified Plastic Surgeons. In our opinion you are just asking for a complication if you do not seek out a Board Certified Plastic Surgeon to perform your surgery. To avoid some of the risks associated with liposuction your Doctor will have you wear compression to the donor area following the procedure. To ensure that as much of the fat as possible sticks around you should avoid anything that will compromise the blood supply to your newly transferred fat. This means avoid compression in this area as well as ice. For example, when a buttock augmentation is performed using fat grafting the patient must avoid sitting directly on their buttocks for 2 weeks.
What is Cytori PureGraft?

Dr. Brooks uses the only FDA approved fat grafting system, Cytori Puregraft®. Puregraft® is a lipofiltration system that allows for a quick preparation of fat for fat transfer in a single-use, sterile, closed environment. The Puregraft® system drains any excess tumescent fluid, (a fluid injected into the body prior to liposuction) free lipids, and blood from the lipoaspirate and then allows the lipoaspirate to be washed with saline using a sterile technique. This ensures that the fat harvested for grafting purposes is uniform and consistent and prepared in a timely fashion, helping the graft have a greater chance of being viable, i.e. more fat take.

What is the truth about Fat Grafting for Breast Augmentation?

Although fat grafting is widely accepted as common practice for things just as facial rejuvenation and adding volume to the buttocks, the jury is still out on using fat for primary breast augmentation, as a substitution for implants. Currently, fat grafting is used to enhance the results of breast reconstruction after mastectomy or lumpectomy and to improve the results of implants by helping to reduce rippling and wrinkling or visibility of implants. Although fat grafting may seem appealing to some patients over an implant, there are some things to consider when making the decision if it right for you. One limiting factor is the volume that can be achieved. Women can expect to achieve less than a cup size in difference with fat grafting, while implants are able to achieve much more volume. The amount achieved is also unpredictable as only 30-50% of the fat injected will establish it's own blood supply and live. The cells that do live also can fluctuate with any weight loss or weight gain causing a difference in breast size with any difference in weight, something that obviously would not happen with a silicone or saline implant. One last consideration is whether or not fat grafting could obscure the readings of future mammograms or be mistaken for early breast cancer. There is not concrete evidence to say one way or the other, but it is a potential risk. Women who have had fat grafting to their breasts or implants should always let the technician know they have had such procedures done prior to any breast studies.

How do I learn more about Fat Grafting?
If you are interested in learning more about Fat Grafting or are wondering if it is the right choice for you, call our office at 413-565-4400 or visit Our Website to book a consultation with Dr. Brooks.

Disclosure: This post is not sponsored by Cytori.

Tuesday, March 5, 2013


As you may have realized from our previous post about sizing for Breast Augmentation, deciding to have a Breast Augmentation is just the beginning of a series of decisions! One of these (very important) decisions is whether to use Silicone Gel Implants or Saline Implants.

left: silicone, right: saline

The majority of our Breast Augmentation patients could go with either Silicone or Saline implants and get a desirable result, however, there are certain patients that we would recommend one vs. the other. Saline implants are more prone to rippling and wrinkling and therefore should be avoided in patients with very little breast tissue as this rippling and wrinkling could be felt and sometimes seen, especially underneath the breasts and laterally along the side of the breast closest to the underarm. Saline is also heavier than silicone and therefore causes more pull on the tissues. This can be a problem if you are going with a very large implant as it can stretch out the tissues leading to premature drooping. Patients who already have some droop of the breast may also want to avoid saline implants as to not increase their problem. The weight of Saline can also be a good thing though, specifically in patients who have tight skin and a tight pectoralis muscle. The weight of a Saline Implant in this body type helps to stretch out the tissues allowing the implant to drop into the bottom of the breast and create a natural shaped breast. Patients who are younger than 22 years old who have never had implants before must also go with a Saline Implant as indicated by law.

A question asked by all of our patients is, are Silicone Implants less safe than Saline? The answer to this is that both implants are equally as safe. Saline Implants actually do have a Silicone hard shell that is then filled with Saline, so in both Implants the Silicone hard shell is what comes in contact with your actual tissue. The issue comes in with the rupturing of the Implants. Silicone and Saline implants, will eventually rupture just as a pair of jeans you wear everyday will eventually get a few holes in the knees. The cause of a rupture is usually not traumatic, but caused simply by wear and tear of the Implant being inside your tissue. That being said, traumatic rupture can occur, particularly with a penetrating trauma. If Saline Implants rupture, the Saline, which is basically salt water will slowly leak out and your body with absorb it and you will notice within a few days that one breast is quite smaller than the other. With Silicone implants, as the Silicone these days is Semi-Cohesive, making it the consistency of jello, the shape/size of the breast will not change. The Silicone will usually create a small bubble at the rupture site and your body may even form a scar around this. Usually this silicone will stay in the pocket where the implant is. This rupture will not cause any signs or symptoms and is therefore referred to as a silent rupture. The FDA recommends that in order to check for this silent rupture patients who have Silicone implants should get an MRI to check for a rupture starting 3 years after implants are placed and continuing every 2 years after that. Unfortunately, the MRI is not covered by your insurance as Breast Augmentation is a cosmetic procedure.

At our practice the majority of our patients end up going with Silicone implants, but as mentioned above, Saline Implants definitely have their place as well! At a consultation with Dr. Brooks he will examine you in order to determine whether a Silicone Implant or a Saline Implant will give you the best result. If you are interested in learning more about Breast Augmentation surgery call the office at 413-565-4400 to make a Consultation with Dr. Brooks.