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Fat Chance?

Doctors are divided on using body fat for breast implants

Fat grafts, or transferring fat from one part of the body to another, have been performed for years to plump up sunken faces and lips, hands thinned by sun exposure, or flat buttocks. However, transferring fat to the breasts rather than using implants has created controversy among doctors. Can women safely have liposuction performed on their lower bodies and use unwanted fat to make breasts fuller without implants? Are there any unknown side effects, and how would this procedure affect women's breast cancer risks?

  Over the last few years, LSU Health Sciences Center plastic surgeon Dr. Kamran Khoobehi performed and studied the procedure on nearly 200 patients. All women in the study had a mammogram before surgery to make sure they didn't have undiagnosed cancers.

  Khoobehi recently brought surgeons from around the world to New Orleans to discuss his results.

  "The biggest group that was reported was from France," Khoobehi says. "They have (done) more than 1,000 fat grafts in the breasts and haven't reported any increased risk of breast cancer in that group."

  Doctors also were concerned about the calcification pattern of fat grafts causing spots on a mammogram that resemble cancer, requiring a woman to undergo a needle biopsy. Radiologists at the conference said any breast procedure or surgery, like a reduction, causes changes on a mammogram, but a radiologist trained to recognize the difference should have no problems.

  "The question is whether radiologists have great difficulty in assessing whether those changes are related to the surgery or to breast cancer development," says Dr. Eva Rubin, a diagnostic radiologist who came to the conference from Montgomery, Ala. "For the most part, it's not a problem. There's always going to be a case where you have some questions and you end up doing a needle biopsy, but that's not a disaster."

  "The calcification pattern (of fat grafts) is totally different than breast cancer calcification," Khoobehi says.

  The fat graft procedure is good for patients experiencing loss of breast volume after pregnancy or implant problems, for those who want to fill a wide space between implants to create cleavage, or to cover rippling or depressions in implants.

  One such patient, a 62-year-old woman who chose not to reveal her identity, experienced scarring, hardening and deformities caused by her breast implants. Her implants were recently removed, and fat from her thighs was transferred to her breasts.

  "Twenty years ago, I had breast implants because I am so out of proportion," she says. "I regret that I ever (got) implants. Over the last 20 years I've had four surgeries (to correct the hardening and deformities)."

  After the fat transfer, her breasts kept their volume without hardening. While before and after pictures show good results for this patient and others like her, doctors who have used fat grafts for cancer patients and breast reconstruction are waiting and watching the studies before using the procedure for enlargement alone. Women who lose a lot of weight after the procedure lose breast volume because transplanted fat from the thighs or abdomen still reacts the same way to diet and exercise — by shrinking. For now, doctors say fat transfer is not a good option for a woman who wants to go from an A cup to a C or D cup.

  "I don't think we're ready as a plastic surgery community to say fat injections for cosmetic or elective breast enhancement are the way to go," says Dr. John Lindsey, chief of plastic and reconstructive surgery at East Jefferson General Hospital. "There are just too many issues that have not been worked out."

  For now, the procedure is becoming more acceptable for certain patients. Doctors have more information about cancer risk, the procedure's effect on mammograms and the best candidates for the procedure, and their experience and techniques for harvesting fat and transferring it are crucial to the procedure's success.

  "For many years, we have been trying to figure out how to get fat to last in the breast, to augment breasts without implants, using (a patient's) own fat," says Dr. William Coleman, a dermatological surgeon in Metairie. "It is conceivable that this may be a very viable procedure for the future."

  "I would say keep your eyes open," Khoobehi says. "Have an open mind."

Look for Meg Farris' Medical Watch reports, including "Weight Loss Wednesday" and "Wrinkle Free Friday" stories, weeknights on WWL-TV Channel 4 and anytime on wwltv.com.

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