Fat Shifting: New, Safe, and Transformative

Rarely in a surgical field does a new technique evolve that completely ‘changes the game.’ For decades, plastic surgery patients have been asking, ‘Can you just take my excess fat from here and put it HERE?’ Now, finally, the safety and efficacy of the fat shifting technique have been worked out, and its usefulness is far greater than expected. Never was it suspected that the fat shifting technique would register on the radar as a germ cell procedure, with rejuvenating value that extended well beyond the mere transfer of volume from one area to another.

Uses in Breast Reconstruction

Radiation treatment has been utilized for decades to limit removal of breast tissue or to treat the recurrence of cancer. Breast reconstruction after radiation has historically been focused on removal or replacement of the irradiated skin, which is often inelastic, stiff, or folded, and not conducive to the reconstructive process. Over recent years, however, we have seen the emergence of fat shifting (or grafting) to the breast to fill contour defects that previously would have required transfer of a muscle or other more vital tissue. For decades, this procedure has been avoided, for fear that fat shifting would cause radiographic changes that would make it more difficult to detect recurring cancer. A large study, however, has recently eliminated the majority of that concern, as the changes after breast reduction surgery were found to be just as confusing as those seen with fat shifting, if not more so. Moreover, the remarkable rejuvenation seen in the face of radiation has since made fat grafting a new mainstay in the field of breast reconstruction. The transformation of irradiated skin prompted investigation that revealed that not only does the diminished radiated blood supply markedly increase, but the transferred fat also contains pluripotent germ cells capable of replacing lost or damaged tissue. Since then, fat shifting has been used to revive irradiated skin rather than remove it, to fill small contour defects after a traditional reconstruction, to supplement soft tissue coverage over an implant reconstruction, and even to completely reconstruct a small breast (through several outpatient fat shifting sessions, rather than longer surgery that requires hospitalization).

Uses in Cosmetic Breast Surgery

Fat shifting into the breast area has increased tremendously since studies have shown that it is not likely that the procedure will lead to erroneous findings on mammograms that could lead to unnecessary biopsies. Many patients who have little breast tissue will need submuscular implants to better camouflage the upper edge of the implant. However, some women would prefer to leave the pectoralis muscle undisturbed. With the use of fat shifting to the breast, patients can see a more natural, full-breasted appearance that cannot be achieved with implants alone. Also, some patients might be able to avoid the more uncomfortable submuscular implant placement altogether by increasing the soft tissue coverage over their subglandular implants. This combination of breast augmentation with implants and shifted fat is called a ‘Composite Augmentation,’ which has become increasingly popular because of the above-mentioned benefits, in addition to the body contouring achieved at the harvest site (which can be the abdomen, back, or thighs, depending on the patients’ fat storage tendencies).

Uses in Cosmetic Facial Surgery

Since the mass marketing of facial fillers, surgeons have been watching patients as they achieve a younger look without lifting or tightening the skin of the face and jawline. We now know that there are two primary processes that contribute to the aged appearance: gravitational descent with loss of elasticity, and atrophy of the fatty tissue of the face. It is this latter process that is ameliorated by the addition of volume. Consequently, there is a trend in face lift surgery to do less lifting and tightening ‘which can give an unnatural look to the face’ ‘“’ and more filling to reverse the atrophy and loss of volume. With the advent of fat shifting, the combination of face or neck lifting surgery with facial fat grafting is rapidly becoming the new standard for rejuvenating the face of the older patient. The amount of tissue needed is small, and can be harvested from the lower abdomen or inner thighs. Fat grafting in the face requires experience, however, and should not be used in the lips or the tear troughs/lower lids. The grafting process also includes the shifting of germ cells, which are implicated in the rejuvenation of radiated skin, which in turn may confer other rejuvenating effects. Hopes are so high for the long-term rejuvenating properties of fat stem cells that tissue banking companies are now offering to freeze and store aspirated fat for use over a patient’s lifetime.

At Bangor Plastic Surgery, we provide a full range of services in a state-of-the-art facility. Visit our website for more information, or call 1-888-501-1855 to schedule your consultation!

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