Photo: Doctor interprets mammograms (AP photo)
UNCERTAINTY ABOUT NEW BREAST TECHNIQUE
Increasing numbers of patients are getting injections of their own fat cells in order to enlarge their breasts or rejuvenate their faces. This trend, which uses fat cells after they’re removed from the body through liposuction, has grown in popularity faster than researchers can study the new technology.
Dr. August Accetta
With the trend showing no signs of abating, two recent studies have reached contradictory conclusions about whether injections of fat and adult stem cells into the breast interfere with identifying early signs of cancer on mammograms.
A Chinese study, published in April in the Plastic and Reconstructive Surgery journal, concluded that fat injections lead to changes in the breast that look like signs of cancer. The researchers called for a ban on fat injections for breast enhancement.
A French study, published in March in the same journal, concluded that fat injections do not interfere with interpretation of mammograms.
Fat injections into the face are offered by dozens of cosmetic doctors nationwide under names such as “Stem-Cell Facelift,” because the fat often is processed to increase its concentration of adult stem cells before it is re-injected.
Breast-enhancing fat injections are less common. Among the doctors offering this procedure are cosmetic surgeons Dr. Hamid A. Towhidian of Irvine and Dr. August Accetta of Huntington Beach, who both call them “Natural Breast Augmentations.”
“Women always ask, ‘Why can’t I just take fat from my buttocks and thighs and put it where I need it the most, my breasts?’ Now they can,” says Accetta, who is board-certified as a obstetrician and gynecologist. He is also a member of the American Academy of Cosmetic Surgery and the American Academy of Cosmetic Gynecologists.
Fat cells in the thighs and buttocks are relatively resistant to change from dieting and exercise, and that characteristic remains even after they are injected into the breast, he says.
“If the patient loses weight, the breasts will retain the same size and shape after injection,” Accetta says.
Fat cells removed via liposuction (1 and 2) are processed (3 and 4) before being re-injected into the breast / Diagram courtesy of Doctor2008.
In their recent studies, both the Chinese and French researchers found tiny deposits of calcium apparently left by fat cells that had died after being injected into the breast. But the researchers disagreed about whether those deposits could be mistaken for evidence of breast cancer.
The Chinese doctors examined mammograms from 48 women whose breasts had been injected with their own fat, called autologous fat, between 1999 and 2009. In 17 percent of them (eight women), doctors spotted tiny deposits of calcium that they considered “highly suspicious” as potential signs of breast cancer.
Biopsies on those women found no cancer, leading the researchers to conclude that the misleading calcium deposits were the remains of dead, injected fat cells. Because of this confusion in reading mammograms, lead researcher Dr. Cong-Feng Wang said such fat injections should be prohibited.
In contrast, French researchers examined mammograms of 31 women who’d had fat injections between 2000 and 2008. Mammograms of 16 percent (five women) had tiny calcium deposits, which the researchers concluded were left by fat cells that had died. None was likely to be mistaken for evidence of cancer, they said.
The medical website MedLexicon reported on the two studies about injections of autologous fat:
“There is a long history of debate over the use of injected fat for breast augmentation. In the late 1980s, the [American Society of Plastic Surgeons] issued a strong statement against the use of this procedure, citing the risk of difficulties in early diagnosis of breast cancer. However, more recent studies have reported that autologous fat injection provides very good results, and that any changes seen on mammograms are easily distinguished from abnormalities related to breast cancer.
“In contrast, the new study finds mammographic abnormalities suspicious for breast cancer in 1 out of 6 women undergoing fat injection for breast augmentation. The clustered microcalcifications [tiny calcium deposits] are indistinguishable from those associated with breast cancer, requiring biopsy to make the correct diagnosis. Because of this issue — and independent of the aesthetic results achieved — Dr. Wang and colleagues strongly believe the use of autologous fat injection for breast augmentation should be discontinued.
“However, that recommendation conflicts with a paper published in the March issue of PRS, which concluded that ‘Radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure.’ The conflicting results highlight the need for caution — and for more scientific evidence on the mammographic changes occurring after fat injection.”
Many cosmetic doctors are doing fat transfers and “stem-cell facelifts.” These include plastic surgeon Dr. Joseph Cruise of Newport Beach; osteopathic cosmetic surgeon Dr. Kevin Sadati of Newport Beach; plastic surgeon Dr. Payman Simoni of Beverly Hills; and Dr. Nathan Newman of Beverly Hills.
PureGraft 250 device from San Diego-based Cytori Therapeutics purifies patients' extracted fat and increases its stem-cell content.
Plastic surgeon Dr. Sam Rizk of New York, who also performs the procedure, says there’s some validity to the name “stem-cell facelift.”
“There is strong evidence that fat contains adult stem cells,” Rizk says on his website. He believes “that these stem cells may be responsible for a rejuvenating effect on the skin and other tissues of the face, other than just a volume-filling effect from fat. ”
But he warns patients: “You may be unhappy with the results also because of the decreased longevity of the fat grafts. It is impossible to predict exactly how long each fat transfer will last in every person because there are differences in absorption in individual patients which depend on genetic factors, stress, smoking, and other factors.”
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