In the technological age, there are more tools out there than ever for surgeons in the plastic surgery realm. That’s opened up a whole new world for patients considering cosmetic surgery to customize their look. From face to glutes and everything in between, cosmetic surgeries are highly individual.
Breast augmentation is one such surgery that gives patients the opportunity to enhance or reduce their bust. In certain breast augmentation procedures, implants can cause complications. One possible problem is anaplastic large cell lymphoma (BIA-ALCL) — a rare type of blood cancer that initially appears in the skin, lymph nodes or other organs throughout the body.
One way to augment is through fat transfers that can be enriched with stem cells. Stem cells exist in normal fat and can be manipulated by chemicals occurring naturally in the human body or those introduced from outside.
The Use of Stem Cells
The ability of stem cells to shape shift can be beneficial in regenerating tissue or adding to tissue that’s already there and can be used to augment body parts like breasts. Doctors can use these stem cells to help reconstruct patients who have had cancer or to combat the aging process. On the negative side, these stem cells can also be turned into rapidly dividing cancer cells — a risk that can be associated with fat grafting.
Dr. Sam Jejurikar, a leading specialist in cosmetic surgery based in Dallas, has said it’s important to acknowledge these risks in a realistic way. Dr. Jejurikar is a member of the highly esteemed Dallas Plastic Surgery Institute. He has worked throughout the Dallas area at Baylor Medical Center, Dallas Day Surgery Center, Forrest Park Medical Center and Texas Health Presbyterian Hospital Dallas. He’s well known for his expertise in gluteal augmentation as well as other specialized kinds of cosmetic surgery.
Jejurikar has been working in the field for the past 21 years, taking a stand for safety within his field in recent years as part of the Multisociety Gluteal Fat Grafting Task Force. The task force is group of experts working to educate doctors and patients on the risks of gluteal augmentation by holding workshops around the country. Jejurikar has been leading the charge while also pushing for safety and improved knowledge about breast augmentation. Part of Jejurikar’s work is addressing his patients fears about BIA-ALCL with pragmatism gained from experience.
“Although we spend a lot of time talking about it, it’s important to remember that it’s an exceedingly rare phenomenon thought to be related to texturing of the breast implant surface; thus it’s not seen with smooth breast implants, which are the most commonly used implants in breast augmentation,” he said.
A Sensitive Procedure
Fat grafting works by taking fat from areas like the abdomen and thighs and injecting it into the breast with liposuction. The injections are made through tiny incisions, and the procedure is usually done while patients are under anesthesia.
The American Society of Plastic Surgeons estimates the lifetime risk of BIA-ALCL to be 1:3,817 – 1:30,000. That data collected over the past 20 years is based on confirmed cases from women with textured implants. The first case of BIA-ALCL was reported in 1996. Since then, the ASPS has recorded approximately 230 cases in the United States and 570 cases worldwide as of July 2018.
The fear of BIA-ALCL has prompted some women to seek alternatives to breast implants. They are starting to look into breast augmentation using their own fat instead, which Jejurikar said has its benefits.
“This has the advantage of avoiding a breast implant while still using their own, naturally occurring fat to give them more volume and greater density to the breasts. The appropriate candidates for this are women who are looking for a natural result with a desired cup size enhancement of one half to one full cup size.”
Fat grafting in cosmetic surgery is a growing field with methods to study its effectiveness emerging daily. According to the West County Plastic Surgeons at Washington University, fat grafting for breast augmentation appears to be the most effective type of surgery for small- to moderate-sized breasts, and is a good option for many considering augmentation.
Ensuring Positive Results
The lasting appearance of breast augmentation depends on a patient’s body and how much they retain the fat that’s injected in a certain area. The amount of grafted fat that stays in the body changes, with different reports ranging from 30-80 percent remaining over time. Doctors can address fat loss through repeated sessions of fat grafting which can help keep the volume originally obtained after surgery. It can also produce larger augmentation over time if that is the patient’s desired result.
Since breast augmentation is a highly individual process, there’s no one-size-fits-all surgery. Implants continue to be popular because they are highly adjustable and, even though risks exists, Jejurikar said they should not be exaggerated.
“Breast implants still remain a great option for patients who seek a more significant augmentation or a round appearance to the breasts after surgery. Most commonly, patients are seeking out highly cohesive gel silicone implants, better known as gummy bear implants. Gummy bear implants come in a variety of densities and shapes, allowing the surgeon to personalize the results to the patient’s desired appearance.”
The American Society of Plastic Surgeons also supports certain kinds of fat grafting while acknowledging the drawbacks to certain procedures. Jejurikar said it’s important for patients to consider what they want their results to be and weigh their options with that in mind.
Jejurikar recommends certain patients who are shooting for a more natural appearance to consider augmentation with their own fat. “It’s also a great option for women who are undergoing a breast lift (mastopexy) and wish to create some upper pole fullness to the breast without using a breast implant. This creates a natural fullness to the upper breast and avoids and ‘augmented’ look,” he said.